Clinical Aspergillus Signatures in COPD and Bronchiectasis

Abstract

Pulmonary mycoses remain a global threat, causing significant morbidity and mortality. Patients with airways disease, including COPD and bronchiectasis, are at increased risks of pulmonary mycoses and its associated complications. Frequent use of antibiotics and corticosteroids coupled with impaired host defenses predispose patients to fungal colonization and airway persistence, which are associated with negative clinical consequences. Notably, Aspergillus species remain the best-studied fungal pathogen and induce a broad spectrum of clinical manifestations in COPD and bronchiectasis ranging from colonization and sensitization to more invasive disease. Next-generation sequencing (NGS) has gained prominence in the field of respiratory infection, and in some cases is beginning to act as a viable alternative to traditional culture. NGS has revolutionized our understanding of airway microbiota and in particular fungi. In this context, it permits the identification of the previously unculturable, fungal composition, and dynamic change within microbial communities of the airway, including potential roles in chronic respiratory disease. Furthermore, inter-kingdom microbial interactions, including fungi, in conjunction with host immunity have recently been shown to have important clinical roles in COPD and bronchiectasis. In this review, we provide an overview of clinical Aspergillus signatures in COPD and bronchiectasis and cover the current advances in the understanding of the mycobiome in these disease states. The challenges and limitations of NGS will be addressed.

Next-Generation Sequencing Applications for the Study of Fungal Pathogens

“…In some cases, NGS started a new era in the field of respiratory infections and has become a feasible alternative to traditional culture. NGS can more readily identify fungus components and dynamic changes in the airway and detect cross-kingdom microbial interactions [ 63 ]. Respiratory microorganisms are identified by collecting sputum or bronchoalveolar lavage fluid (BALF) samples.…”

Pathogen Distribution, Drug Resistance Risk Factors, and Construction of Risk Prediction Model for Drug-Resistant Bacterial Infection in Hospitalized Patients at the Respiratory Department During the COVID-19 Pandemic

“…[31][32][33]35,39 Most patients in the general respiratory ward, particularly those admitted to the RICU, are often characterized by advanced age, need for mechanical ventilation support, immunocompromised, and combined structural lung disease, and are prone to co-infection with fungal infections. 40,41 Excessive antifungal drug exposure may alter the composition of the flora, whereas the combination of antimicrobial drugs may promote resistance gene mutations, thereby causing bacterial resistance. 42 Ghannoum et al also supported our research.…”

Evaluation of metagenomic next‐generation sequencing diagnosis for invasive pulmonary aspergillosis in immunocompromised and immunocompetent patients

“…Chronic pulmonary aspergillosis or allergic bronchopulmonary aspergillosis (ABPA) develops when the host immune response is normal or excessive, 7,19,20 and Aspergillus can also be isolated from the respiratory cultures of these patients 21 . Most non‐immunocompromised patients have chronic lung diseases, and the anatomical structure is abnormal, which is conducive to the colonisation of Aspergillus 4–6 ; However, Aspergillus colonisation may also develop into IPA with the progressive destruction of lung architecture 22,23 . Although Aspergillus can be detected in the lower respiratory tract of both immunosuppressed and non‐immunosuppressed patients, the pathogenicity varies due to differences in host immunity.…”

“…The mNGS Aspergillus reads in the IPA group were higher than those in the non-IPA group the progressive destruction of lung architecture. 22,23 Although…”