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J Cyst Fibros. 2019 Mar;18(2):227-232. doi: 10.1016/j.jcf.2018.08.012. Epub 2018 Oct 6.

Combined antifungal therapy is superior to monotherapy in pulmonary scedosporiosis in cystic fibrosis.

Author information

1
Christiane Herzog Zentrum Berlin/Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany. Electronic address: carsten.schwarz@charite.de.
2
Christiane Herzog Zentrum Berlin/Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
3
Klinikum Erlangen, Loschgestraße 15, 91054 Erlangen, Germany.
4
CF-Zentrum Hamburg-Altona, Friesenweg 2, 22763 Hamburg, Germany.
5
Labor Lademannbogen MVZ Hamburg, Lademannbogen 61, 22339 Hamburg, Germany.
6
Klinikum Kassel, Mönchebergstraße 41-43, 34125 Kassel, Germany.
7
Klinikum Oldenburg, Rahel-Straus-Straße 10, 26133 Oldenburg, Germany.
8
Angers University Hospital, 4 rue Larrey, 49933 Angers Cedex 9, France.
9
Helios Klinikum Buch, Schwanebecker Chaussee 50, 13125 Berlin, Germany.
10
Universitätsklinikum Ulm, Eythstr. 24, 89075 Ulm, Germany.
11
Universitätsklinikum des Saarlandes, Kirrberger Straße, 66421 Homburg, Germany.
12
Klinikum Worms, Gabriel-von-Seidl-Straße 81, 67550 Worms, Germany.
13
Universitätsklinikum Tübingen, Hoppe-Seyler-Str. 1, 72076 Tübingen, Germany.
14
Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
15
Robert Koch Institute, Nordufer 20, 13353 Berlin, Germany.

Abstract

Cystic fibrosis (CF) is characterised by chronic airway infection with bacteria and fungi. Infections caused by Scedosporium/Lomentospora species can occur and are difficult to treat. Moulds belonging to the genus Scedosporium/Lomentospora are detected most frequently in respiratory samples of patients with CF, next to Aspergillus spp. Our aim was to define pulmonary fungal infections due to Scedosporium/Lomentospora in CF and to study the antimycotic treatment. In this multicentre study (12 centres; duration January 2008 to December 2014) 31 patients with a lung infection caused by moulds of the genus Scedosporium/Lomentospora were included. 36 courses of antifungal treatment were documented. Scedosporium apiospermum sensu stricto accounted for 48.4% of cases. In 20/31 patients a therapeutic response under antimycotics (median duration 3.9 months) was achieved. Triple and double therapy was significantly more effective compared to monotherapy regarding FEV1, radiology, and symptoms. This data suggests that combined treatment is superior to monotherapy in patients with CF.

KEYWORDS:

Anti-fungal treatment; Mycosis; Pneumonia

PMID:
30297214
DOI:
10.1016/j.jcf.2018.08.012

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