Urban Life as Risk Factor for Aspergillosis

Abstract

Aspergillus fumigatus (Af) frequently colonizes the airways of patients with cystic fibrosis (CF) and can cause severe diseases, such as allergic bronchopulmonary aspergillosis, Af bronchitis or even Af pneumonia. However, risk factors, including environmental factors, for acquiring Af in the respiratory tract of patients with CF are rarely studied and described. The aim of this study was to investigate whether urban or rural life could affect colonization with Af in the respiratory tract of patients with CF. Due to privacy policy, registry data are usually not linked to patients´home addresses. It is therefore very difficult to analyze the influence of the patient´s residential environment. This prospective questionnaire survey was carried out in 31 German CF centers in 2018. Only completed surveys, including a clearly assigned type of residential area were included. Statistical analysis was performed by chi-squared test and logistic regression models. A total of 1016 questionnaires were analyzed (Patients`age: 23 ± 13; 0-88 years; female gender: n=492; 48%). The majority of patients with CF live in large cities (n =314; 30.9%) or urban districts (n=461; 45.4%). Prevalence of 30.2% was found for Af, within the 12 months of investigation period. Af colonization was significantly associated with urban life (p=0.004). Urban live should be considered as possible new risk factor for colonization with Af in the respiratory tract of patients with CF. These new results may raise the awareness of the influence of environmental factors on patient outcomes and should be included in patient guidance and preventive measures.

Demographic and Socioeconomic Factors Associated with Fungal Infection Risk, United States, 2019

“…Aspergillosis likely is more frequently diagnosed in higher income patients because of their ability to continually seek treatment for associated risk factors. Income differences also could relate to cost of living because aspergillosis is more likely to be diagnosed in urban than rural patients (32).…”

Pulmonary Aspergillosis in People with Cystic Fibrosis

“…All these risk factors should be taken into account during exacerbations of the disease, especially when laboratory tests confirm colonization, and there is no response after administration of appropriate medications. 6,67,[73][74][75] Implementation of highly effective CFTR modulators during the last few years has been a breakthrough in CF care. However, the chronic inflammation and infection with bacteria and fungi in the CF airways are still outstanding challenges.…”

“…67 68 69 Two more recent studies reported an age of acquisition being 16.4 years in the United States, 13.5 years in France, and 9.0 years in the United Kingdom. 66 67 68 69 70 71 72 73 Two other studies have broken down the prevalence of A. fumigatus colonization into different age categories showing colonization rates of 16.4% up to 28% in children <12 years of age. By differentiating transient (≤1/year) from persistent (≥2/year) colonization, Saunders et al showed that children <12 years of age were only transiently colonized in a minority of the cases (21%), with the majority of children ≥12 years (59%) being persistently colonized with Aspergillus .…”

“…By differentiating transient (≤1/year) from persistent (≥2/year) colonization, Saunders et al showed that children <12 years of age were only transiently colonized in a minority of the cases (21%), with the majority of children ≥12 years (59%) being persistently colonized with Aspergillus . 71 73 Cultures from bronchoalveolar lavage fluid (BALF) showed a significantly higher yield of A. fumigatus compared to sputum samples taken in the same period. Valuable data were obtained from an Australian study in which infants diagnosed with CF after newborn screening underwent BALF at 3 months, 1 year, and 2 years.…”

The Multifaceted Role of Mating Type of the Fungus and Sex of the Host in Studies of Fungal Infections in Humans

“…Aspergillus fumigatus frequently colonizes the airways of patients with cystic fibrosis and can cause severe disease such as allergic bronchopulmonary aspergillosis, A. fumigatus bronchitis, or even A. fumigatus pneumonia. Urban living should be considered as a possible new risk factor for A. fumigatus colonization of the airways of cystic fibrosis patients [ 47 ].…”