Background: The prevalence of fungal disease in cystic fibrosis (CF) and non-CF bronchiectasis is increasing and the clinical spectrum is widening. Poor sensitivity and a lack of standard diagnostic criteria renders interpretation of culture results challenging. In order to develop effective management strategies, a more accurate and comprehensive understanding of the airways fungal microbiome is required. The study aimed to use DNA sequences from sputum to assess the load and diversity of fungi in adults with CF and non-CF bronchiectasis. Methods: Next generation sequencing of the ITS2 region was used to examine fungal community composition (n = 176) by disease and underlying clinical subgroups including allergic bronchopulmonary aspergillosis, chronic necrotizing pulmonary aspergillosis, non-tuberculous mycobacteria, and fungal bronchitis. Patients with no known active fungal disease were included as disease controls. Results: ITS2 sequencing greatly increased the detection of fungi from sputum. In patients with CF fungal diversity was lower, while burden was higher than those with non-CF bronchiectasis. The most common operational taxonomic unit (OTU) in patients with CF was Candida parapsilosis (20.4%), whereas in non-CF bronchiectasis sputum Candida albicans (21.8%) was most common. CF patients with overt fungal bronchitis were dominated by Aspergillus spp. , Exophiala spp., Candida parapsilosis or Scedosporium spp. Conclusion: This study provides a framework to more accurately characterize the extended spectrum of fungal airways diseases in adult suppurative lung diseases.
The role of Aspergillus in the absence of established CF-allergic bronchopulmonary aspergillosis remains unclear. The following review discusses new approaches proposed to categorise the extended spectrum of CF Aspergillus disease, highlighting the need for enhanced microbiological investigation and serological monitoring of patients in light of evidence which differentiates colonization from categories of greater pathogenic potential.
Background: Cystic fibrosis (CF) and non-CF bronchiectasis (BX) are lung diseases characterised by severe chronic infections. Fungal and bacterial components of infection are both recognized. Recent molecular investigation of sputum from patients with CF and BX has revealed a complex mycobiome. However, little is known about how fungal and bacterial organisms interact or whether the interactions impact on disease outcomes. Methods: Quantitative PCR and next generation sequencing of ITS2 and 16S rRNA gene was carried out on 107 patients with CF and BX and defined clinical fungal infection status. Fungal and bacterial communities were explored using supervised and unsupervised machine learning to understand associations between fungal and bacterial communities and their relationship to disease. Results: Fungal and bacterial communities both had significantly higher biomass and lower diversity in CF compared to BX patients. Random forest modelling demonstrated that the fungal and bacterial communities were distinct between CF and BX patients. Within the CF group, bacterial communities contained no predictive signal for fungal disease status. Neither bacterial nor fungal community composition were predictive of the presence of CF pulmonary exacerbation (CFPE). Intra-kingdom correlations were far stronger than those between the two kingdoms. Dirichlet mixture components analysis identified two distinct clusters of bacteria related to the relative abundance of Pseudomonas. Fungal community composition contained no predictive signal for bacterial clusters. Conclusions: Clear changes in diversity were observed between patients with different clinical disease status. Although our results demonstrate that bacterial community composition differs in the presence of fungal disease, no direct relationship between bacterial and fungal OTUs was found.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.