Efficacy of ltraconazole treatment on Aspergillus funiigatus sputum isolate and serum markers in cystic fibrosis.

M.L. Belli, B. Tubino, M.C. Diana, G. Manno, E. Ugolotti, M.L. Fenu, L. Minicucci, L. Romano, C. Jannuzzi, C. Romano.

Abstract: 

The role of Aspergillus fumigatus (Af) presence in sputa from Cystic Fibrosis (CF) patients is still controversial: fungal enzymes (e.g. elastase) can contribute to lung disease and allergic sensitization to Af can lead to ABPA. Treatment of Af can be preventive of lung damage. In order to assess the efficacy of antifungal treatment in CF patients, Af sputum isolation and serum markers were retrospectively evaluated. In the last three years, 89 out of about 2400 sputum cultures from CF patients, revealed the presence of Af. In our series, the prevalence of patients with at least one positive culture for Af remained around 5-1 0%. Fungal research was specifically requested in 55/89, referring to 45 episodes of positive sputum culture in 16 CF patients; sputum positivities in the same patient were considered separate episodes when at least nine months had elapsed in between. 17145 episodes (all in patients with clinical symptoms andlor with elevated total and specific lgE) were treated. Indication to treatment was generally based on the presence of clinical manifestations (wheezing and/or dry cough) andlor of serological markers of sensitization to Af ([email protected] and specific lgE). Treatment consisted in oral administration of 400 mgldie of Itraconazole for 1 month followed by 200 mg/die for other two months, at least. Patients were monitored clinically and by sputum culture every three months. We considered Af cleared after at least two consecutively negative cultures (whether treated or not). Sputum culture follow-up of the 17 treated episodes showed disappearance of Af in 9 (53%), decrease of Af colonies in 5 (10%) and no variation in 3 (17%). Clinical manifestations improved or disappeared during treatment in 60% of patients, whereas no aerological modification was observed. Other 28 episodes of At isolation in the sputum were not treated. In 9128 (32%) Af spontaneously disappeared from sputum culture and persisted in 19128 (68%). In all, Itraconazole therapy determined the disappearance or the decrease of Af quantity in sputum cultures in 83% of treated episodes. This result is statistically significant when compared to Af disappearance frequency (32%) in non-treated episodes (Chi-square 14.83, p
1997

abstract No: 

NULL

Full conference title: 

7th European Respiratory Society Annual Conference
    • ERS 17th (2007)