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Original Research: Genetic and Developmental Disorders |

IgE-Mediated Immune Responses and Airway Detection of Aspergillus and Candida in Adult Cystic FibrosisAspergillus and Candida in Cystic Fibrosis

Caroline G. Baxter, PhD; Caroline B. Moore, PhD; Andrew M. Jones, MD; A. Kevin Webb, MD; David W. Denning, MD
Author and Funding Information

From the National Aspergillosis Centre (Drs Baxter and Denning), Manchester Adult Cystic Fibrosis Unit (Drs Baxter, Jones, and Webb), and Mycology Reference Laboratory (Dr Moore), University Hospital of South Manchester, and School of Translational Medicine (Drs Baxter, Moore, and Denning), University of Manchester, Manchester, England.

Correspondence to: Caroline G. Baxter, PhD, 2nd Floor Education and Research Centre, University Hospital of South Manchester, Southmoor Rd, Manchester M23 9LT, England; e-mail: caroline.baxter@manchester.ac.uk


Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.

Funding/Support: This study was supported by the National Commissioning Group, National Aspergillosis Centre, University Hospital of South Manchester.


Chest. 2013;143(5):1351-1357. doi:10.1378/chest.12-1363
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Background:  The recovery of Aspergillus and Candida from the respiratory secretions of patients with cystic fibrosis (CF) is common. Their relationship to the development of allergic sensitization and effect on lung function has not been established. Improved techniques to detect these organisms are needed to increase knowledge of these effects.

Methods:  A 2-year prospective observational cohort study was performed. Fifty-five adult patients with CF had sputum monitored for Aspergillus by culture and real-time polymerase chain reaction and Candida by CHROMagar and carbon assimilation profile (API/ID 32C). Skin prick tests and ImmunoCAP IgEs to a panel of common and fungal allergens were performed. Lung function and pulmonary exacerbation rates were monitored over 2 years.

Results:  Sixty-nine percent of patient sputum samples showed chronic colonization with Candida and 60% showed colonization with Aspergillus. There was no association between the recovery of either organism and the presence of specific IgE responses. There was no difference in lung function decline for patients with Aspergillus or Candida colonization compared with those without (FEV1 percent predicted, P = .41 and P = .90, respectively; FVC % predicted, P = .87 and P = .37, respectively). However, there was a significantly greater decline in FEV1 and increase in IV antibiotic days for those sensitized to Aspergillus (FEV1 decline, P = .03; IV antibiotics days, P = .03).

Conclusions:  Allergic sensitization is not associated with recovery of Candida or Aspergillus from the sputum of patients with CF. Aspergillus but not Candida sensitization is associated with greater lung function decline and pulmonary exacerbations.


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