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J Cyst Fibros. 2018 Dec 1. pii: S1569-1993(18)30939-1. doi: 10.1016/j.jcf.2018.11.012. [Epub ahead of print]

Prevalence and diversity of filamentous fungi in the airways of cystic fibrosis patients - A Dutch, multicentre study.

Author information

1
Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands; Center of Expertise in Mycology Radboudumc/CWZ, Nijmegen, The Netherlands. Electronic address: Tobias.Engel@radboudumc.nl.
2
Department of Pediatrics, Radboud University Medical Center, Nijmegen, The Netherlands.
3
Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands; Center of Expertise in Mycology Radboudumc/CWZ, Nijmegen, The Netherlands.
4
Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital (CWZ), Nijmegen, The Netherlands.
5
Center of Expertise in Mycology Radboudumc/CWZ, Nijmegen, The Netherlands; Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital (CWZ), Nijmegen, The Netherlands.

Abstract

BACKGROUND:

Progressive lung injury in Cystic Fibrosis (CF) patients can lead to chronic colonization with bacteria and fungi. Fungal colonization is obtained from the environment which necessitates locally performed epidemiology studies. We prospectively analyzed respiratory samples of CF patients during a 3-year period, using a uniform fungal culture protocol, focusing on filamentous fungi and azole resistance in Aspergillus fumigatus.

METHODS:

Over a 3-year period, all respiratory specimens collected from CF patients in 5 Dutch CF centers, were analyzed. Samples were inoculated onto the fungal culture media Sabouraud dextrose agar (SDA) and Medium B+. All fungal isolates were collected and identified in one centre, using Amplified Fragment Length Polymorphism (AFLP) fingerprinting, rDNA PCR and ITS, calmodulin and β-tubulin sequencing. Azole resistance was assessed for all A. fumigatus using a qPCR assay followed by phenotypic confirmation.

RESULTS:

Filamentous fungi were recovered from 699 patients from at least one respiratory sample, corresponding with 3787 cultured fungal species. A. fumigatus was cultured most often with a mean prevalence of 31.7%, followed by Penicillium species (12.6%), non-fumigatus Aspergillus species (5.6%), Scedosporium species (4.5%) and Exophiala dermatitidis and Cladosporium species (1.1% each). In total 107 different fungal species were identified, with 39 Penicillium species and 15 Aspergillus species. Azole resistance frequency in A. fumigatus was 7.1%, with TR34/L98H being the dominant resistance mechanism.

CONCLUSION:

A vast diversity of filamentous fungi was demonstrated, dominated by Aspergillus and Penicillium species. We observed a mean azole resistance prevalence of 7.1% of A. fumigatus culture positive patients.

KEYWORDS:

Aspergillus; Azole resistance; Cystic Fibrosis; Epidemiology; Filamentous fungi; Penicillium

PMID:
30514613
DOI:
10.1016/j.jcf.2018.11.012

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