Background: To study the prevalence chronic pulmonary aspergillosis (CPA) in patients with cystic fibrosis (CF).
Material/methods: In Prospective study in 2014-2016 y.y. we included 115 patients with CF. The mean age of the patients was 11 years (range 1 - 37), 59 male and 56 female. All patients underwent determination of IgG to Aspergillus fumigatus. Bronchoalveolar lavage (BAL) and sputum were examined by direct microscopy and culture. In case of CPA suspicion computed tomography of the chest was performed. The diagnosis of CPA was established with D. Denning 2016 criteria.
Results: IgG to Aspergillus fumigatus was detected in 47 patients (41%). Aspergillus spp. in BAL and sputum were revealed in 22 patients (19%): Aspergillus fumigatus - in 14 patients (12%), Aspergillus niger - in 6 patients (5%), Aspergillus flavus - in 2 patients (2%). Chronic pulmonary aspergillosis was diagnosed in 5 cases (4,3%). All the patients with CPA received oral and inhaled antibiotics, four patients (80%) had chronic respiratory colonization of Pseudomonas aeruginosa and one patient - Proteus mirabilis, three patients with CPA were homo- or heterozygous for the mutation F508del
(60%). One patient (20%) underwent liver transplantation nine months before. Clinical manifestations of CPA in patients with CF were: exacerbation of CF (100%), cough (100 %), hemoptysis (60 %), fever (40 %), dyspnea (20 %). Low lung function (FEV1% <70%) was in 3 (60%) patients. In all patients with CPA were detected IgG to Aspergillus fumigatus and Aspergillus spp. in culture sputum. Etiology of CPA was Aspergillus niger in 2 patients (40%), Aspergillus flavus in 2 patients (40%), .Aspergillus fumigatus in 1 patients (20%). The abnormalities chest CT scan were central bronchiectasis (100%), infiltrates and focal changes (80%), and aspergilloma (20%). All patients with CPA received antifungal treatment. Overage duration of antifungal treatment in patients with CPA were 86 days (14-210), voriconazole was used in 100%,
posaconazole – in 40%. Overall survival in 6 months was 100%.
Conclusions: Сhronic pulmonary aspergillosis occurs in 4,3% patients with cystic fibrosis. The risk factors of chronic pulmonary aspergillosis were oral and inhaled antibiotics, chronic respiratory colonization of Pseudomonas aeruginosa and Proteus mirabilis, homo- or heterozygous for the mutation F508del. Etiology of chronic pulmonary aspergillosis: A. niger, A. flavus and A. fumigatus. Clinical signs chronic pulmonary aspergillosis were cough, fever, and hemoptysis. Overall survival in 6 months was 100%.
Full conference title:
- ECCMID 27th (2017)