Coinfection with Pseudomonas aeruginosa and Aspergillus fumigatus in cystic fibrosis. (18th November 2020)

• Record Type: Journal Article
• Authors: Keown, Karen; Reid, Alastair; Moore, John E.; Taggart, Clifford C.; Downey, Damian G.
• Is Part Of: European respiratory review. Volume 29:Number 158(2020)
• Publication Date: 2020-11-18
• Subjects: Respiratory organs -- Diseases -- Periodicals; Respiratory Tract Diseases; Respiratory organs -- Diseases; Respiratory organs -- Diseases -- Treatment; Electronic journals; Periodical; Periodicals; Periodicals; 616.2
• DOI: 10.1183/16000617.0011-2020
• Languages: English
• ISSNs: 0905-9180

Abstract

Objectives: Cystic fibrosis (CF) lung disease is characterised by mucus stasis, chronic infection and inflammation, causing progressive structural lung disease and eventual respiratory failure. CF airways are inhabited by an ecologically diverse polymicrobial environment with vast potential for interspecies interactions, which may be a contributing factor to disease progression. Pseudomonas aeruginosa and Aspergillus fumigatus are the most common bacterial and fungal species present in CF airways respectively and coinfection results in a worse disease phenotype. Methods: In this review we examine existing expert knowledge of chronic co-infection with P. aeruginosa and A. fumigatus in CF patients. We summarise the mechanisms of interaction and evaluate the clinical and inflammatory impacts of this co-infection. Results: P. aeruginosa inhibits A. fumigatus through multiple mechanisms: phenazine secretion, iron competition, quorum sensing and through diffusible small molecules. A. fumigatus reciprocates inhibition through gliotoxin release and phenotypic adaptations enabling evasion of P. aeruginosa inhibition. Volatile organic compounds secreted by P. aeruginosa stimulate A. fumigatus growth, while A. fumigatus stimulates P. aeruginosa production of cytotoxic elastase. Conclusion: A complex bi-directional relationship exists between P. aeruginosa and A. fumigatus, exhibiting both mutually antagonistic and cooperative facets. Cross-sectional data indicate a worsened disease state in coinfected patients; however, robust longitudinal studies are required to derive causality and to determine whether interspecies interaction contributes to disease progression. A complex relationship exists between P. aeruginosa and A. fumigatus and is associated with worsened clinical disease in cystic fibrosis. Further study of organism interactions, longitudinal outcomes and therapeutic strategies is warranted. https://bit.ly/2A161bh