Bronchopulmonary mycoses in cystic fibrosis. Results of a five-year longitudinal study

Due to the defective mucociliary clearance, different fungal species can co lonize the respiratory tract of patients with cystic fibrosis (CF), sometim es leading to infections. However, the pathogenic effects of these fungi ar e not well established. Objective. The aim of this longitudinal epidemiological study was to specif y the frequency of bronchopulmonary mycoses in CE and to define the etiolog ic role of the different fungal species in these diseases. Material and methods. Over a period of five years, 128 CF patients, 4 to 35 -years-old, were clinically followed and screened for the presence of fungi in sputum samples and for the occurrence of related serum antibodies. The clinical data were then compared with mycological and serological results, paying attention to symptoms of infectious or allergic bronchopulmonary dis eases. Results and conclusions. Isolated from bronchial secretions in 46.1 % of th e patients, Aspergillus fumigatus induced an allergic bronchopulmonary aspe rgillosis (ABPA) in five cases, which corresponded to an incidence of 0.97 % per year. ABPA was the main fungal disease in our study, but its frequenc y was not as high as previously reported. Aspergillus fumigatus was also responsible for asthma in two patients. Due to the overlap of symptoms with ABPA, to the high rate of atopy in CF patie nts, and to the great diversity of causal allergens, it is not easy to diag nose asthma and to discern an Aspergillus etiology. Recovered in 8.6 % of patients, Scedosporium apiospermum was the second mos t frequent filamentous fungus isolated from sputum samples. For three patie nts, it was involved in allergic bronchopulmonary features, either alone or in association with A. fumigatus. No apparent respiratory disease was caus ed by the other filamentous fungi isolated from bronchial secretions, most often episodically. Finally, despite the high isolation rate of Candida albicans from sputum sa mples and the presence of numerous predisposing factors in CF patients, a u nique case of severe candidiasis was observed. This very low incidence of c andidiasis in CF could be related to an antifungal activity of bacteria col onizing the respiratory tract. However, the pathogenic role of C. albicans by means of hypersensitivity phenomena remains unknown.