Aspergillus Infections and Progression of Structural Lung Disease in Children with Cystic Fibrosis

被引：50

作者：

Breuer, Oded ^{[1
,3
,4
]}

Schultz, Andre ^{[1
,2
,4
]}

Garratt, Luke W. ^{[1
]}

Turkovic, Lidija ^{[1
]}

Rosenow, Tim ^{[1
,2
]}

Murray, Conor P. ^{[5
]}

Karpievitch, Yuliya, V ^{[1
]}

Akesson, Lauren ^{[1
,6
,7
]}

Dalton, Samuel ^{[8
]}

Sly, Peter D. ^{[9
]}

Ranganathan, Sarath ^{[6
,8
,10
]}

Stick, Stephen M. ^{[1
,2
,4
]}

Caudri, Daan ^{[1
,4
,11
]}

机构：

[1] Univ Western Australia, Telethon Kids Inst, Perth, WA, Australia

[2] Univ Western Australia, Fac Med & Dent, Div Child Hlth, Perth, WA, Australia

[3] Hadassah Hebrew Univ, Dept Pediat, Pediat Pulm Unit, Med Ctr, Jerusalem, Israel

[4] Perth Childrens Hosp, Dept Resp & Sleep Med, Perth, WA, Australia

[5] Perth Childrens Hosp, Dept Diagnost Imaging, Perth, WA, Australia

[6] Univ Melbourne, Dept Paediat, Melbourne, Vic, Australia

[7] Murdoch Childrens Res Inst, Victorian Clin Genet Serv, Melbourne, Vic, Australia

[8] Royal Childrens Hosp, Dept Resp Med, Parkville, Vic, Australia

[9] Univ Queensland, Child Hlth Res Ctr, Childrens Hlth & Environm Program, Brisbane, Qld, Australia

[10] Murdoch Childrens Res Inst, Parkville, Vic, Australia

[11] Erasmus Med Ctr Sophia, Dept Pediat Resp Med, Rotterdam, Netherlands

来源：

AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE | 2020年 / 201卷 / 06期

基金：

英国医学研究理事会;

关键词：

cystic fibrosis; Aspergillus; trapped air; bronchiectasis; lung disease progression; CHEST COMPUTED-TOMOGRAPHY; YOUNG-CHILDREN; PSEUDOMONAS-AERUGINOSA; FUMIGATUS COLONIZATION; RISK-FACTORS; INFLAMMATION; INFANTS; SPUTUM; BRONCHIECTASIS; EXACERBATIONS;

D O I：

10.1164/rccm.201908-1585OC

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Rationale: Recent data show that Aspergillus species are prevalent respiratory infections in children with cystic fibrosis (CF). The biological significance of these infections is unknown. Objectives: We aimed to evaluate longitudinal associations between Aspergillus infections and lung disease in young children with CF. Methods: Longitudinal data on 330 children participating in the Australian Respiratory Early Surveillance Team for Cystic Fibrosis surveillance program between 2000 and 2018 who underwent annual chest computed tomography (CT) imaging and BAL were used to determine the association between Aspergillus infections and the progression of structural lung disease. Results were adjusted for the effects of other common infections, associated variables, and repeated visits. Secondary outcomes included inflammatory markers in BAL, respiratory symptoms, and admissions for exacerbations. Measurements and Main Results: Haemophilus influenzae, Staphylococcus aureus, Pseudomonas aeruginosa, and Aspergillus infections were all associated with worse CT scores in the same year (P-overall < 0.05). Only P. aeruginosa and Aspergillus were associated with progression in CT scores in the year after an infection and worse CT scores at the end of the observation period. P. aeruginosa was most significantly associated with development of bronchiectasis (difference, 0.9; 95% confidence interval, 0.3-1.6; P= 0.003) and Aspergillus with trapped air (difference, 3.2; 95% confidence interval, 1.0-5.4; P = 0.004). Aspergillus infections were also associated with markers of neutrophilic inflammation (P < 0.001) and respiratory admissions risk (P = 0.008). Conclusions: Lower respiratory Aspergillus infections are associated with the progression of structural lung disease in young children with CF. This study highlights the need to further evaluate early Aspergillus species infections and the feasibility, risk, and benefit of eradication regimens.

引用

页码：688 / 696

页数：9

共 42 条

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