Routine processing procedures for isolating filamentous fungi from respiratory sputum samples may underestimate fungal prevalence

Pashley, Catherine H.; Fairs, Abbie; Morley, J. P.; Tailor, Shreeya; Agbetile, Joshua; Bafadhel, Mona; Brightling, Christopher E.; Wardlaw, Andrew J.

doi:10.3109/13693786.2011.615762

Cited by 102 publications

(96 citation statements)

References 20 publications

(28 reference statements)

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“…All COPD subjects underwent lung function testing including reversibility testing [17]. Sputum was collected for analysis of routine microbiology for potential pathogenic microorganisms (defined as Haemophilus influenzae, Moraxella catarrhalis, Streptococcus pneumoniae, Staphylococcus aureus or Pseudomonas aeruginosa) [18] and mycology [15,19]. In brief, ,150 mg of undiluted sputum was inoculated onto potato dextrose agar plates containing chloramphenicol (16 mg?mL -1 ), gentamicin (4 mg?mL -1 ) and fluconazole (5 mg?mL -1 ).…”

Section: Subjects and Measurementsmentioning

confidence: 99%

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Aspergillus fumigatus during stable state and exacerbations of COPD

Bafadhel

McKenna²,

Agbetile³

et al. 2013

European Respiratory Journal

126

127

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Bacteria are often isolated in stable chronic obstructive pulmonary disease (COPD). Whether fungi are also commonly present and associated with clinical and pathological features of disease is uncertain. We investigated the frequency of filamentous fungal culture and IgE sensitisation to Aspergillus fumigatus and the relationship to clinical outcomes in COPD subjects.COPD subjects were recruited to enter a 1-year observational study. Assessments of lung function, allergen testing and sputum analysis for inflammation, bacteria and fungus were undertaken in COPD subjects and healthy smoking and nonsmoking controls.Filamentous fungi were cultured at baseline in 49% (63 out of 128) of COPD subjects, of which 75% (47 out of 63) were A. fumigatus. Fungus was cultured in three out of 22 controls (two were A. fumigatus). The total sputum cell count and inhaled corticosteroid dosage were significantly increased in COPD patients with a positive filamentous fungal culture at baseline (p,0.05). Sensitisation to A. fumigatus was present in 13% of COPD subjects and was associated with worse lung function (forced expiratory volume in 1 s 39% predicted versus 51% predicted; p50.01), but not related to filamentous fungal culture.A. fumigatus sensitisation is related to poor lung function. Positive filamentous fungal culture is a common feature of COPD. The clinical significance of this remains uncertain. @ERSpublications A. fumigatus sensitisation links to poor COPD lung function; clinical significance of positive fungal culture is unclear

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Section: Subjects and Measurementsmentioning

confidence: 99%

“…A. fumigatus colonies were identified by colony formation and microscopy. PCR sequencing of the large subunit or the internal transcribed spacer region of the nuclear ribosomal operon was used for the detection of other filamentous fungi, as previously described [19].…”

Section: Subjects and Measurementsmentioning

confidence: 99%

Aspergillus fumigatus during stable state and exacerbations of COPD

Bafadhel

McKenna²,

Agbetile³

et al. 2013

European Respiratory Journal

126

127

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“…Culture of multiple samples increases yield in those with allergic bronchopulmonary aspergillosis [33,34], which is probably true for all forms of pulmonary aspergillosis. Routine-processing procedures for isolating filamentous fungi from respiratory sputum samples underestimate Aspergillus airway infection; sputum plugs separated from saliva and inoculation of aliquots of ∼150 mg directly onto potato dextrose agar increases the yield [35]. Culture from higher volume, undiluted respiratory specimens has a much higher yield for Aspergillus than the UK Health Protection Agency standard culture method [36].…”

Section: Diagnostic Criteriamentioning

confidence: 99%

Chronic pulmonary aspergillosis: rationale and clinical guidelines for diagnosis and management

Denning¹,

Cadranel²,

et al. 2015

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Chronic pulmonary aspergillosis (CPA) is an uncommon and problematic pulmonary disease, complicating many other respiratory disorders, thought to affect ∼240 000 people in Europe. The most common form of CPA is chronic cavitary pulmonary aspergillosis (CCPA), which untreated may progress to chronic fibrosing pulmonary aspergillosis. Less common manifestations include: Aspergillus nodule and single aspergilloma. All these entities are found in non-immunocompromised patients with prior or current lung disease. Subacute invasive pulmonary aspergillosis (formerly called chronic necrotising pulmonary aspergillosis) is a more rapidly progressive infection (<3 months) usually found in moderately immunocompromised patients, which should be managed as invasive aspergillosis. Few clinical guidelines have been previously proposed for either diagnosis or management of CPA. A group of experts convened to develop clinical, radiological and microbiological guidelines. The diagnosis of CPA requires a combination of characteristics: one or more cavities with or without a fungal ball present or nodules on thoracic imaging, direct evidence of Aspergillus infection (microscopy or culture from biopsy) or an immunological response to Aspergillus spp. and exclusion of alternative diagnoses, all present for at least 3 months. Aspergillus antibody (precipitins) is elevated in over 90% of patients. Surgical excision of simple aspergilloma is recommended, if technically possible, and preferably via video-assisted thoracic surgery technique. Long-term oral antifungal therapy is recommended for CCPA to improve overall health status and respiratory symptoms, arrest haemoptysis and prevent progression. Careful monitoring of azole serum concentrations, drug interactions and possible toxicities is recommended. Haemoptysis may be controlled with tranexamic acid and bronchial artery embolisation, rarely surgical resection, and may be a sign of therapeutic failure and/or antifungal resistance. Patients with single Aspergillus nodules only need antifungal therapy if not fully resected, but if multiple they may benefit from antifungal treatment, and require careful follow-up. @ERSpublications ERS and ESCMID guideline for the management of chronic pulmonary aspergillosis released

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“…Selection for treatment with antifungals therefore requires careful identification of patients with active bronchitis reflecting heavy fungal colonization, as shown by culture of airway secretions. As methods for sputum fungal culture are not standardized or quantified and often insensitive [124], fungal bronchitis is not well recognized or characterized. Fungal bronchitis, however, is a common problem in all airway diseases irrespective of IgE sensitization and often involves yeast as well as filamentous fungi.…”

Section: Antifungal Therapymentioning

confidence: 99%

Allergic Fungal Airway Disease

Rick¹,

Woolnough²,

Pashley³

et al. 2016

J Investig Allergol Clin Immunol

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Fungi are ubiquitous and form their own kingdom. Up to 80 genera of fungi have been linked to type I allergic disease, and yet, commercial reagents to test for sensitization are available for relatively few species. In terms of asthma, it is important to distinguish between species unable to grow at body temperature and those that can (thermotolerant) and thereby have the potential to colonize the respiratory tract. The former, which include the commonly studied Alternaria and Cladosporium genera, can act as aeroallergens whose clinical effects are predictably related to exposure levels. In contrast, thermotolerant species, which include fungi from the Candida, Aspergillus, and Penicillium genera, can cause a persistent allergenic stimulus independent of their airborne concentrations. Moreover, their ability to germinate in the airways provides a more diverse allergenic stimulus, and may result in noninvasive infection, which enhances inflammation. The close association between IgE sensitization to thermotolerant filamentous fungi and fixed airflow obstruction, bronchiectasis, and lung fibrosis suggests a much more tissue-damaging process than that seen with aeroallergens. This review provides an overview of fungal allergens and the patterns of clinical disease associated with exposure. It clarifies the various terminologies associated with fungal allergy in asthma and makes the case for a new term (allergic fungal airway disease) to include all people with asthma at risk of developing lung damage as a result of their fungal allergy. Lastly, it discusses the management of fungirelated asthma. Key words: Thermotolerant fungi. Allergic fungal airway disease (AFAD). ABPA. SAFS. Asthma. Allergic fungal rhinosinusitis (AFRS). Immune responses. Diagnosis. Treatment. ResumenLos hongos son obicuos y forman su propio reino. Hasta 80 géneros de hongos han sido asociados con la enfermedad alérgica tipo I; sin embargo, los reactivos comerciales para testar las sensibilizaciones a los mismos, se encuentran disponibles para un número relativamente pequeño de especies. En cuanto al asma, es importante distinguir entre especies incapaces de crecer en temperatura ambiente y aquellas que son termotolerantes y que, por lo tanto, tienen una capacidad potencial para colonizar el tracto respiratorio. Los primeros, que incluyen los géneros comúnmente estudiados Alternaria y Cladosporium, pueden actuar como aeroalérgenos y sus efectos clínicos están relacionados con los niveles de exposición. En contraste, las especies termotolerantes, que incluyen hongos del género Candida, Aspergillus y Penicillium, pueden causar un estímulo alergénico persistente independiente de su concentración en el aire. Además, su capacidad para germinar en las vías aéreas da lugar a estímulos alergénicos más diversos y puede dar como resultado infecciones no invasivas que facilitan la inflamación. La estrecha asociación entre sensibilización dependiente de IgE a hongos filamentosos termotolerantes y la obstrucción del flujo aéreo, bronquiectasias y fib...

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Routine processing procedures for isolating filamentous fungi from respiratory sputum samples may underestimate fungal prevalence

Cited by 102 publications

References 20 publications

Aspergillus fumigatus during stable state and exacerbations of COPD

Aspergillus fumigatus during stable state and exacerbations of COPD

Chronic pulmonary aspergillosis: rationale and clinical guidelines for diagnosis and management

Allergic Fungal Airway Disease

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