PURPOSE: Improved survival in CF has been seen with aggressive antibiotic usage. However, identification of new bacteria and fungi from sputa of CF patients is increasingly being reported. The clinical implications of these isolates remain unknown. Recently, Exophiala (Wangiella) dermatitidis (Ed), has been identified in sputum of cystic fibrosis (CF) patients. The purpose of this study was to report our recent experience of this pathogen and determine any clinical significance in CF patients.
METHODS: All respiratory cultures of CF patients attending BCCH CF Clinic between Jan 2008 - Jan 2010 were screened. Charts were reviewed for all patients who had >1 positive culture for Ed and information regarding clinical status, co-infection and management was recorded.
RESULTS: 7/120(6%) patients isolated Ed ≥1 occasion during the 2yr period. The age range of patients was 10-18 years (median: 14yrs; Male: 4). Co-isolates included S. aureus (including MRSA), P. aeruginosa, B cepacia, H. parainfluenzae, S. maltophilia and A. fumigatus. 5/7(71%) patients isolated atypical mycobacteria(3/5 M. abscessus, 1/5 M avium complex & 1/5 M. abscessus & M avium complex) during the same time period as having Ed. 3 co-isolated both organisms simultaneously and 2 isolated Ed within 4 months after culturing atypical mycobacteria. The median change in FEV1% predicted 6 months post 1st isolation was -5% (Range -16 to +1%) and the median change in absolute BMI value was -0.4kg/m2 (Range -0.9 to +0.6kg/m2). 6/7(86%) of patients had ≥1 hospital admission for treatment of pulmonary symptoms during the time Ed was isolated.Treatment with oral Voriconazole was given to 3 patients with variable response.
CONCLUSION: 1)The clinical significance of Ed infection and response to treatment is difficult to determine in this small series2)Co-infection with atypical mycobacteria may be significant.
CLINICAL IMPLICATIONS: 1)Isolation of Ed in CF patients may contribute to clinical findings and require specific therapy.2)The high rate of co-infection with atypical mycobacteria suggests it may be important to actively search for this pathogen in patients isolating Ed failing to respond to therapy.
DISCLOSURE: Jasneek Chawla, No Financial Disclosure Information; No Product/Research Disclosure Information