Respiratory Fungal Infections in Cystic Fibrosis: Diagnostic and Therapeutic Challenges

Abstract

Purpose of Review In cystic fibrosis (CF), the main focus in bronchopulmonary infections is on bacterial pathogens, as they significantly influence lung function and the exacerbation rate. In the last decade, fungal respiratory diseases have been increasingly investigated for their impact on the clinical course of people with CF. This review aims to highlight recent findings in diagnostics and therapeutic approaches in terms of fungal infections in CF. Recent Findings We reviewed over 100 publications on fungal species in CF. Studies showed that Aspergillus spp. negatively impact lung function in patients with CF. A summary of these investigations showed that fungal diseases in patients with CF present as colonization, sensitization, bronchitis, pneumonia, allergic bronchopulmonary aspergillosis, and aspergilloma. Two significant fungal infections, pneumonia and bronchitis, are now well-defined, and several studies have established treatment options. The following pathogens are considered the primary cause of bronchitis, i.e., Aspergillus spp. and Exophiala spp., and of pneumonia, i.e., Scdedosporium spp., Apergillus spp., Trichosporon spp., and Candida spp. The main therapeutic innovations highlighted were real-time PCR techniques, DNA chips, and antigen-reactive T cell enrichment assay (ARTE). Summary Respiratory fungal infections in CF are a complex task in terms of definition and therapy.