Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2021 Mar 22:14:1141-1153.
doi: 10.2147/IDR.S267219. eCollection 2021.

Managing Fungal Infections in Cystic Fibrosis Patients: Challenges in Clinical Practice

Lauren C Magee  1 , Mariam Louis  2 , Vaneeza Khan  3 , Lavender Micalo  3 , Nauman Chaudary  3
Affiliations
Review

Managing Fungal Infections in Cystic Fibrosis Patients: Challenges in Clinical Practice

Lauren C Magee et al. Infect Drug Resist. .

Abstract

Cystic Fibrosis (CF) is an autosomal recessive disease characterized by a mutation in the cystic fibrosis transmembrane conductance regulator (CFTR) protein. Impairment of the CFTR protein in the respiratory tract results in the formation of thick mucus, development of inflammation, destruction of bronchial tissue, and development of bacterial or fungal infections over time. CF patients are commonly colonized and/or infected with fungal organisms, Candida albicans or Aspergillus fumigatus, with prevalence rates ranging from 5% to 78% in the literature. Risk factors for acquiring fungal organisms include older age, coinfection with Pseudomonas aeruginosa, prolonged use of oral and inhaled antibiotics, and lower forced expiratory volume (FEV1). There are limited data available to differentiate between contamination, colonization, and active infection. Furthermore, the pathogenicity of colonization is variable in the literature as some studies report a decline in lung function associated with fungal colonization whereas others showed no difference. Limited data are available for the eradication of fungal colonization and the treatment of active invasive aspergillosis in adult CF patients. In this review article, we discuss the challenges in clinical practice and current literature available for laboratory findings, clinical diagnosis, and treatment options for fungal infections in adult CF patients.

Keywords: ABPA; Aspergillus; Aspergillus bronchitis; Candida; colonization; cystic fibrosis; fungal infection.

PubMed Disclaimer

Conflict of interest statement

Vaneeza Khan and Lavender Micalo work as research volunteers with Dr. Chaudary. Dr. Chaudary is a Professor of Medicine and Director of the Adult Cystic Fibrosis Center at Virginia Commonwealth University Medical Center. The authors have received no financial compensation for this review article. Dr. Chaudary was involved in the Continued Medical Education (CME) activity for Michael J. Hennessy (MJH) Events, reports clinical non-profit service grant from CFF, is part of the advisory board for PARI, provided CME talk for Abcomm inc, outside the submitted work. The authors have no other conflicts of interest with any companies or organizations whose products or services may be discussed in this article.

Figures

Figure 1
Figure 1
Chronicity and pathogenicity of fungal organisms in cystic fibrosis. Data from Tracy and Moss.
See this image and copyright information in PMC

References

    1. Davies JC, Alton E, Bush A. Cystic fibrosis. BMJ. 2007;335(7632):1255–1259. doi:10.1136/bmj.39391.713229.AD - DOI - PMC - PubMed
    1. Sanders DB, Bittner RCL, Rosenfeld M, Hoffman LR, Redding GJ, Goss CH. Failure to recover to baseline pulmonary function after cystic fibrosis pulmonary exacerbation. Am J Respir Crit Care Med. 2010;182(5):627–632. doi:10.1164/rccm.200909-1421OC - DOI - PMC - PubMed
    1. Yankaskas JR, Marshall BC, Sufian B, Simon RH, Rodman D. Cystic fibrosis adult care: consensus conference report. Chest. 2004;125(1 Suppl):1S–39S. - PubMed
    1. Tracy MC, Moss RB. The myriad challenges of respiratory fungal infection in cystic fibrosis. Pediatr Pulmonol. 2018;53(S3):S75–S85. doi:10.1002/ppul.24126 - DOI - PubMed
    1. Kraemer R, Delosea N, Ballinari P, Gallati S, Creameri R. Effect of allergic bronchopulmonary aspergillosis on lung function in children with cystic fibrosis. Am J Respir Crit Care Med. 2006;174(11):1211–1220. doi:10.1164/rccm.200603-423OC - DOI - PubMed

LinkOut - more resources