The Turkish Journal of Pediatrics 2020 , Vol 62 , Num 4
Diverse clinical characteristics of Aspergillus growth in patients with cystic fibrosis
Nagehan Emiralioğlu 1 ,Deniz Doğru 1 ,Özlem Doğan 2 ,Dolunay Gülmez 2 ,Sevtap Arıkan Akdağlı 2 ,Sanem Eryılmaz Polat 1 ,Gökçen Tuğcu 1 ,Mina Gharibzadeh Hızal 1 ,Ebru Yalçın 1 ,Uğur Özçelik 1 ,Burçin Şener 2 ,Nural Kiper 1
1 Departments of Pediatric Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
2 Departments of Clinical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
DOI : 10.24953/turkjped.2020.04.005 Background and objectives. Patients with cystic fibrosis (CF) have a varying spectrum of clinically significant Aspergillus disease in addition to allergic bronchopulmonary aspergillosis (ABPA). Here we aimed to review the different clinical phenotypes related with Aspergillus growth on the airway culture of patients with CF, we also aimed to investigate the effect of Aspergillus growth on lung function tests.

Method. The medical records of 100 patients with CF who had Aspergillus growth on airway culture within the period of April 2001 and June 2016 were retrospectively analyzed. Age, gender, symptoms, physical examination findings, pulmonary function tests, the diagnosis of ABPA, and airway culture results were recorded for every visit. Patients with Aspergillus growth on airway cultures were classified into different groups as ABPA, Aspergillus sensitization, Aspergillus colonization and Aspergillus bronchitis.

Results. Medical records of 83 patients and 147 sputum cultures were attained from 100 patients. The mean age of the patients was 17.6±7.6 years and the mean age of the first Aspergillus growth in sputum culture was 12.5±6.7 years. At first isolation, Aspergillus fumigatus SC was the most common Aspergillus SC in sputum (76.3%) and 14.5% of these patients required hospitalization. Aspergillus sensitization was diagnosed in 3.6% (n= 3) of the patients. Aspergillus colonization was diagnosed in 18.1% (n= 15) of all patients and led to a decline in FEV1%, FVC% and FEF25-75% which was not statistically significant, furthermore. ABPA was detected in 9.6% (n= 8) of all patients and led to a statistically significant decline in FEV1% (p= 0.02); nonsignificant decline in FVC% and FEF25-75%. Aspergillus bronchitis was detected in 43.4% (n= 36) of all patients and led to nonsignificant decline in FEV1%, FVC% and FEF25-75%.

Conclusion. ABPA is recognized as the most common Aspergillus associated disorder in CF patients and is related to deteriorated pulmonary function tests; however Aspergillus colonization and bronchitis may also be associated with worsening lung function. Keywords : cystic fibrosis, aspergillus colonization, aspergillus sensitization, ABPA, aspergillus bronchitis

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