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Vol. 44. Issue 3.
Pages 146-151 (January 2008)
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Vol. 44. Issue 3.
Pages 146-151 (January 2008)
Original Articles
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Aspergillus fumigatus and Candida albicans in Cystic Fibrosis: Clinical Significance and Specific Immune Response Involving Serum Immunoglobulins G, A, and M
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Luis Máiza,
Corresponding author
lmaiz.hrc@salud.madrid.org

Correspondence: Dr L. Máiz Unidad de Fibrosis Quística, Hospital Ramón y Cajal Ctra Colmenar, km 9.128034 Madrid, Spain
, Manuela Cuevasb, Adelaida Lamasa, Aurora Sousac, Santiago Quirced, Lucrecia Suáreza
a Unidad de Fibrosis Quística, Hospital Ramón y Cajal, Madrid, Spain
b Servicio de Inmunología, Hospital Ramón y Cajal, Madrid, Spain
c Servicio de Microbiología, Hospital Ramón y Cajal, Madrid, Spain
d Servicio de Alergia, Hospital Universitario La Paz, Madrid, Spain
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Objective

The aim of this study was to analyze the clinical significance of Aspergillus fumigatus and Candida albicans in respiratory secretions from patients with cystic fibrosis and to assess the immune response to these fungi in serum.

Patients and methods

The study included 66 patients with cystic fibrosis (34 men; mean age, 16.2 years). Sera from 15 healthy individuals were used as controls.

Results

The serum concentrations of immunoglobulin (Ig) G, IgA, and IgM against A fumigatus and C albicans were higher in patients than in the control group. There was no correlation between the presence of A fumigatus in respiratory secretions and the immune response to the fungus measured in serum. In contrast, the presence of C albicans in respiratory secretions was correlated with the immune response to that fungus. The likelihood of obtaining A fumigatus cultures from respiratory secretions increased with age. The presence of these fungi in respiratory samples was not a risk factor for greater respiratory impairment.

Conclusions

In response to increased colonization of the lower respiratory tract by A fumigatus and C albicans, patients with cystic fibrosis have elevated serum levels of IgG, IgA, and IgM against those fungi. In patients with cystic fibrosis, culture of sputum and oropharyngeal secretions is adequate for the assessment of lower respiratory tract colonization by C albicans but not A fumigatus. Fungal colonization of the lower respiratory tract is not a risk factor for greater respiratory impairment in patients with cystic fibrosis.

Key words:
Aspergillus fumigatus
Candida albicans
Cystic fibrosis
Fungal colonization
Objetivo

Estudiar el significado clínico de Aspergillus fumigatus y Candida albicans en las secreciones respirato-rias de los pacientes con fibrosis quística (FQ) y las inmuno-rrespuestas séricas frente a estos hongos.

Pacientes y métodos

Se estudió a 66 pacientes con FQ (34 varones; edad media: 16,2 años). Como grupo control se utilizaron los sueros de 15 individuos sanos.

Resultados

Las concentraciones de inmunoglobulina (Ig) G, IgA e IgM frente a A. fumigatus y C. albicans estuvieron más elevadas en los pacientes con FQ que en el grupo control. No hubo correlación entre el hallazgo de A. fumigatus en las secreciones respiratorias y las inmunorrespuestas séricas frente al hongo. Sí hubo correlación entre la presencia de C. albicans en las secreciones respiratorias y las inmunorrespuestas frente a C. albicans. A medida que aumentaba la edad de los pacientes, aumentaba la probabilidad de cultivar A. fumigatus en las secreciones respiratorias. La presencia de estos hongos en muestras respiratorias no fue un factor de riesgo para un mayor deterioro respiratorio.

Conclusiones

Como respuesta a la elevada colonización del aparato respiratorio inferior por A. fumigatus y C. albicans, los pacientes con FQ presentan respuestas séricas elevadas de IgG, IgA e IgM frente a estos hongos. En los pacientes con FQ el cultivo de esputos y aspirados orofaríngeos no sirve para evaluar la colonización del aparato respiratorio inferior por A. fumigatus, pero sí por C. albicans. En estos pacientes, la colonización fúngica del aparato respiratorio inferior no es un factor de riesgo para el deterioro respiratorio.

Palabras clave:
Aspergillus fumigatus
Candida albicans
Fibrosis quística
Colonización fúngica
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References
[1]
R Blaschke-Hellmessen, H Spitzer, KD Paul, C Hoffmann.
Mycological surveillance of children with cystic fibrosis.
Mycoses, 34 (1991), pp. 43-47
[2]
JL Burns, JM van Dalfsen, RM Shawar, KL Otto, RL Garber, JM Quan, et al.
Effect of chronic intermittent administration of inhaled tobramycin on respiratory microbial flora in patients with cystic fibrosis.
J Infect Dis, 179 (1999), pp. 1190-1196
[3]
CE Milla, CL Wielinsky, WE Regelmann.
Clinical significance of the recovery of Aspergillus species from the respiratory secretions of cystic fibrosis patients.
[4]
N Bakare, V Rickerts, J Bargon, G Just-Nubling.
Prevalence of Aspergillus fumigatus and other fungal species in the sputum of adult patients with cystic fibrosis.
Mycoses, 46 (2003), pp. 19-23
[5]
A Bauernfeind, R Bertele, K Harms, G Horl, R Jungwirth, C Petermuller, et al.
Qualitative and quantitative microbiological analysis of sputa of 102 patients with cystic fibrosis.
Infection, 4 (1987), pp. 270-277
[6]
L Máiz, M Cuevas, S Quirce, JF Cañón, A Pacheco, A Sousa, et al.
Serologic IgE immune responses against Aspergillus fumigatus and Candida albicans in patients with cystic fibrosis.
Chest, 121 (2002), pp. 782-788
[7]
JM el-Dahr, R Fink, R Selden, LK Arruda, TA Platts-Mills, PW Heymann.
Development of immune responses to Aspergillus at an early age in children with cystic fibrosis.
Am J Respir Crit Care Med, 150 (1994), pp. 1513-1518
[8]
RL Gibson, JL Burns, BW Ramsey.
Pathophysiology and management of pulmonary infections in cystic fibrosis.
Am J Respir Crit Care Med, 168 (2003), pp. 918-951
[9]
K Brown, M Rosenthal, A Bush.
Fatal invasive aspergillosis in an adolescent with cystic fibrosis.
Pediatr Pulmonol, 27 (1999), pp. 130-133
[10]
P Laufer, JN Fink, WT Bruns, GF Unger, JH Kalbfleisch, PA Greenberger, et al.
Allergic bronchopulmonary aspergillosis in cystic fibrosis.
J Allergy Clin Immunol, 73 (1984), pp. 44-48
[11]
R Zeaske, WT Bruns, JN Fink, PA Greenberger, H Colby, JL Liotta, et al.
Immune responses to Aspergillus in cystic fibrosis.
J Allergy Clin Immunol, 82 (1988), pp. 73-77
[12]
LK Arruda, BJ Mann, MD Chapman.
Selective expression of a major allergen and cytotoxin, Asp fI, in Aspergillus fumigatus. Implications for the immunopathogenesis of Aspergillus-related diseases.
J Immunol, 149 (1992), pp. 3354-3359
[13]
L Máiz, F Baranda, R Coll, C Prados, M Vendrell, A Escribano, et al.
Normativa del diagnóstico y el tratamiento de la afección respiratoria en la fibrosis quística.
Arch Bronconeumol, 37 (2001), pp. 316-324
[14]
V Gutiérrez, MJ Olivera, RM Girón, F Rodríguez-Salvanés, P Caballero.
Fibrosis quística en adultos: acuerdos inter e intraobservador para las escalas de puntuación de Brasfield y Chrispin-Norman en la radiografía de tórax y relación con datos clínicos y espirométricos.
Arch Bronconeumol, 41 (2005), pp. 553-559
[15]
J Sanchis, P Casán, J Castillo, N González, R Palenciano, J Roca.
Normativa para la práctica de la espirometría forzada.
Arch Bronconeumol, 25 (1989), pp. 132-134
[16]
PH Quanjer, GJ Tammeling, JE Cotes, OF Pedersen, R Peslin, JC Yernault.
Lung volumes and forced ventilatory flows. Report Working Party Standardization of Lung Function Tests, European Community for Steel and Coal. Official Statement of the European Respiratory Society.
Eur Respir J Supl, 16 (1993), pp. 5-40
[17]
B Przyklenk, A Bauernfeind, G Horl, G Emminger.
Serologic response to Candida albicans and Aspergillus fumigatus in cystic fibrosis.
Infection, 15 (1987), pp. 308-310
[18]
C Wojnarowski, I Eichler, C Gartner, M Gotz, S Renner, DY Koller, et al.
Sensitization to Aspergillus fumigatus and lung function in children with cystic fibrosis.
Am J Respir Crit Care Med, 155 (1997), pp. 1902-1907
[19]
R Burrel, R Rylander.
A critical review of the role of precipitins in hypersensitivity pneumonitis.
Eur J Respir Dis, 62 (1981), pp. 332-343
[20]
LK Arruda, A Muir, LD Vailes, RF Selden, TA Platts-Mills, MD Chapman.
Antibody responses to Aspergillus fumigatus allergens in patients with cystic fibrosis.
Int Arch Allergy Immunol, 107 (1995), pp. 410-411
[21]
L Máiz, M Cuevas, S Quirce, A Pacheco, H Escobar.
Allergic bronchopulmonary aspergillosis with low serum IgE levels in a child with cystic fibrosis.
J Allergy Clin Immunol, 100 (1997), pp. 431-432
[22]
J Mullins, A Seaton.
Fungal spores in lung and sputum.
Clin Allergy, 8 (1978), pp. 525-533
[23]
PS Hutcheson, AJ Rejent, RG Slavin.
Variability in parameters of allergic bronchopulmonary aspergillosis in patients with cystic fibrosis.
J Allergy Clin Immunol, 88 (1991), pp. 390-394
[24]
DW Warnock, DC Speller, JA Morris, PH Mackie.
Serological diagnosis of infection of the urinary tract by yeast.
J Clin Pathol, 29 (1976), pp. 836-840
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