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Aspergillus Species in Bronchiectasis: Challenges in the Cystic Fibrosis and Non-cystic Fibrosis Airways

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Abstract

Bronchiectasis is a chronic irreversible airway abnormality associated with infectious agents that either cause or superinfect the airways. While the role of bacteria is well studied, much remains to be determined about fungi in both cystic fibrosis- and non-cystic fibrosis-related bronchiectasis. The airway is constantly exposed to inhaled ambient moulds of which Aspergillus represent the most ubiquitous. In a normal healthy host, this situation is of little consequence. The presence of anatomical or immunological abnormalities such as those in bronchiectasis leads to a range of fungal-related pathologies from asymptomatic airway colonization to fungal sensitization, allergic bronchopulmonary aspergillosis or chronic pulmonary aspergillosis. These entities are difficult to recognize, diagnose and treat due in part to a lack of validated biomarkers. Our true understanding of the complex relationships that regulate fungal–host interactions is still in its infancy and, several questions remain. This includes if fungal epidemiology in bronchiectasis is uniform across countries, and to what extent immunopathological mechanisms—related to fungal airway infections—occurs in different disease states. Specific triggers to allergic or infectious responses to Aspergillus require further exploration. How transition occurs between allergic and invasive phenotypes and their respective biomarkers is also important. Whether anti-fungal treatment is warranted in all cases and what the optimal management strategy is, particularly when treatment should commence and its expected duration remains unclear. Further research is clearly necessary and should be prioritized to better understand the clinical effects and impact of Aspergillus in the setting of bronchiectasis.

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Abbreviations

CF:

Cystic fibrosis

COPD:

Chronic obstructive pulmonary disease

CPA:

Chronic pulmonary aspergillosis

CVID:

Common variable immunodeficiency

ABPA:

Allergic bronchopulmonary aspergillosis

ABPM:

Allergic bronchopulmonary mycosis

BAL:

Bronchoalveolar lavage

CT:

Computed tomography

HRCT:

High-resolution computed tomography

CXR:

Chest radiography

CGD:

Chronic granulomatous disease

IPA:

Invasive pulmonary aspergillosis

IA:

Invasive aspergillosis

Th2:

T-helper 2 cells

Ig:

Immunoglobulin

rAsp:

Recombinant Aspergillus antigen

TARC:

Thymus activation and regulated chemokine

CFU:

Colony forming units

VDR:

Vitamin D receptor

OX40L:

OX 40 ligand

MBL:

Mannan binding lectin

NTM:

Non-tuberculous mycobacteria

EAACI:

European Academy of Allergy and Clinical Immunology

SAFS:

Severe asthma with fungal sensitization

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Acknowledgements

This research is supported by the Singapore Ministry of Health’s National Medical Research Council under its Transition Award (NMRC/TA/0048/2016) (S.H.C).

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Authors and Affiliations

  1. Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore

    Sanjay H. Chotirmall

  2. Department of Microbiology, Vall D’Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain

    Maria Teresa Martin-Gomez

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  1. Sanjay H. Chotirmall
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  2. Maria Teresa Martin-Gomez
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Correspondence to Sanjay H. Chotirmall.

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Chotirmall, S.H., Martin-Gomez, M.T. Aspergillus Species in Bronchiectasis: Challenges in the Cystic Fibrosis and Non-cystic Fibrosis Airways. Mycopathologia 183, 45–59 (2018). https://doi.org/10.1007/s11046-017-0143-7

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  • DOI: https://doi.org/10.1007/s11046-017-0143-7

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