Background: Progressive lung injury in Cystic Fibrosis (CF) patients can lead to chronic colonization with bacteria and fungi. Fungal colonization is obtained from the environment which necessitates locally performed epidemiology studies. We prospectively analyzed respiratory samples of CF patients during a 3-year period, using a uniform fungal culture protocol, focusing on filamentous fungi and azole resistance in Aspergillus fumigatus. Methods: Over a 3-year period, all respiratory specimens collected from CF patients in 5 Dutch CF centers, were analyzed. Samples were inoculated onto the fungal culture media Sabouraud dextrose agar (SDA) and Medium B+. All fungal isolates were collected and identified in one centre, using Amplified Fragment Length Polymorphism (AFLP) fingerprinting, rDNA PCR and ITS, calmodulin and β-tubulin sequencing. Azole resistance was assessed for all A. fumigatus using a qPCR assay followed by phenotypic confirmation. Results: Filamentous fungi were recovered from 699 patients from at least one respiratory sample, corresponding with 3787 cultured fungal species. A. fumigatus was cultured most often with a mean prevalence of 31.7%, followed by Penicillium species (12.6%), non-fumigatus Aspergillus species (5.6%), Scedosporium species (4.5%) and Exophiala dermatitidis and Cladosporium species (1.1% each). In total 107 different fungal species were identified, with 39 Penicillium species and 15 Aspergillus species. Azole resistance frequency in A. fumigatus was 7.1%, with TR 34 /L98H being the dominant resistance mechanism. Conclusion: A vast diversity of filamentous fungi was demonstrated, dominated by Aspergillus and Penicillium species. We observed a mean azole resistance prevalence of 7.1% of A. fumigatus culture positive patients.
PurposeCoordination in supply chains and networks calls for information sharing among the members of the supply chain. Accordingly, information visibility – the availability of relevant information for making supply chain related decisions is an important concept in the context of supply chain management. The purpose of this paper is to identify the different dimensions of information visibility and propose a framework based on these information visibility dimensions. The proposed framework can be used to evaluate supply chain information systems (SCIS) and their contribution towards information visibility in supply chains.Design/methodology/approachUsing the proposed framework, we compare two different SCIS (SAP APO and SupplyOn) to assess the extent to which these systems meet the information visibility needs within supply chains and networks. In order to carry out the comparison, data regarding the two systems in collected using multiple methods such as from system documentations, training sessions, interviews with experts and systems engineers.FindingsThe findings indicate that both systems perform well in terms of supporting information visibility, however they serve different purposes within supply chains and networks. Based on the findings, the authors discuss the role of different types of SCIS depending on the characteristics of adopting firms and their supply chains, and how the use of these different systems can complement each other. The research and practical implications of this study are discussed in the overall context of supply chain management.Originality/valueThe framework can be used by organizations to assess the extent to which relevant information is accessible within their supply chains and to select from various SCIS solutions that are available. This research advances understanding on ways of achieving information visibility.
We collected sputum samples and cough plates from 15 cystic fibrosis patients in the Netherlands who were colonized with Aspergillus fumigatus; we recovered A. fumigatus of the same genotype in cough aerosols and sputum samples from 2 patients. The belief that transmission of A. fumigatus from cystic fibrosis patients does not occur should be reconsidered.
Aspergillus fumigatus is a saprobic fungus that causes a range of pulmonary diseases, some of which are characterised by fungal persistence such as is observed in cystic fibrosis (CF) patients. Creation of genetic variation is critical for A. fumigatus to adapt to the lung environment, but biofilm formation, especially in CF patients, may preclude mutational supply in A. fumigatus due to its confinement to the hyphal morphotype. We tested our hypothesis that genetic variation is created through parasexual recombination in chronic biofilms by phenotypic and genetic analysis of A. fumigatus isolates cultured from different origins.As diploids are the hallmark of parasex, we screened 799 A. fumigatus isolates obtained from patients with CF, chronic pulmonary lung disease, acute invasive aspergillosis and from the environment for spore size. Benomyl sensitivity, nuclear content measurements through fluorescence activated cell sorting and scanning electron microscopy were used to confirm the diploid state of large size spores. Whole genome sequencing was used to characterise diploid associated genetic variation.We identified 11 diploids in isolates recovered from six of 11 (55%) CF-patients and from one of 24 (4%) chronic aspergillosis patients, but not in 368 isolates from acute infection and the environment. Diploid formation was associated with accumulation of mutations and variable haploid offspring including a voriconazole-resistant isolate.Parasexual recombination allows A. fumigatus to adapt and persist in CF patients, and plays a role in azole resistance development. Our findings are highly significant for understanding the genetics and biology of A. fumigatus in the human lung.
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