Prospective multicenter German study on pulmonary colonization with Scedosporium /Lomentospora species in cystic fibrosis: Epidemiology and new association factors

• DOI: 10.1371/journal.pone.0171485
• Publication Date: 2017-02-08T21:05:48Z
• Authors: Carsten Schwarz; Claudia Brandt; Elisabeth Antweiler; Alexander Krannich; Doris Staab; Sabina Schmitt-Grohé; Rainald Fischer; Dominik Hartl; Anja Thronicke; Kathrin Tintelnot
• Keywords: Adult; Male; 0301 basic medicine; Adolescent; Cystic Fibrosis; Science; 610 Medizin; 610; Opportunistic Infections; Cohort Studies; Young Adult; 03 medical and health sciences; Risk Factors; Germany; Odds Ratio; Prevalence; Humans; Registries; Scedosporium; Child; ddc:610; Lung Diseases, Fungal; Q; R; Middle Aged; Respiratory Function Tests; 3. Good health; Cardiovascular and Metabolic Diseases; Case-Control Studies; Medicine; Female; Research Article

An increasing rate of respiratory colonization and infection in cystic fibrosis (CF) is caused by fungi of the Scedosporium apiospermum species complex or Lomentospora prolificans (Sac-Lp). These fungi rank second among the filamentous fungi colonizing the CF airways, after Aspergillus fumigatus. However, the epidemiology, clinical relevance and risk of pulmonary colonization with Sac-Lp are rarely understood in CF. The objective of the present prospective multicenter study was to study pathogen distribution and determine association factors of pulmonary Sac-Lp colonization in patients with CF.Clinical, microbiological and laboratory data of 161 patients aged 6-59 years with CF in Germany were analyzed for Sac-Lp distribution and association factors. The free statistical software R was utilized to investigate adjusted logistic regression models for association factors.Of the 161 patients included in the study, 74 (56%) were male. The median age of the study cohort was 23 years (interquartile range 13-32 years). 58 patients of the total cohort (36%) were < 18 years old. Adjusted multivariate regression analysis revealed that Sac-Lp colonization was associated with younger age (OR 0.8684, 95%CI: 0.7955-0.9480, p<0.005) and less colonization with H. influenzae (OR 0.0118, 95%CI: 0.0009-0.1585, p<0.001). In addition, Sac-Lp-colonized patients had more often allergic bronchopulmonary aspergillosis (ABPA) (OR 14.6663, 95%CI: 2.1873-98.3403, p<0.01) and have been colonized more often with the mucoid phenotype of Pseudomonas aeruginosa (OR 9.8941, 95%CI: 1.0518-93.0705, p<0.05).Newly found association of ABPA and Pseudomonas revealed new probable risk factors for Sac-Lp colonization. Allergy might play a role in inducing immunologic host reactions which lead to a less effective response to species of Sac-Lp.