Coinfection with Pseudomonas aeruginosa and Aspergillus fumigatus in cystic fibrosis
Objectives Cystic fibrosis (CF) lung disease is characterised by mucus stasis, chronic infection and inflammation, causing progressive structural lung disease and eventual respiratory failure. CF airways are inhabited by an ecologically diverse polymicrobial environment with vast potential for inter...
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Published in | European respiratory review Vol. 29; no. 158; p. 200011 |
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Main Authors | , , , , |
Format | Journal Article |
Language | English |
Published |
European Respiratory Society
31.12.2020
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Subjects | |
Online Access | Get full text |
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Summary: | Objectives
Cystic fibrosis (CF) lung disease is characterised by mucus stasis, chronic infection and inflammation, causing progressive structural lung disease and eventual respiratory failure. CF airways are inhabited by an ecologically diverse polymicrobial environment with vast potential for interspecies interactions, which may be a contributing factor to disease progression.
Pseudomonas aeruginosa
and
Aspergillus fumigatus
are the most common bacterial and fungal species present in CF airways respectively and coinfection results in a worse disease phenotype.
Methods
In this review we examine existing expert knowledge of chronic co-infection with
P. aeruginosa
and
A. fumigatus
in CF patients. We summarise the mechanisms of interaction and evaluate the clinical and inflammatory impacts of this co-infection.
Results
P. aeruginosa
inhibits
A. fumigatus
through multiple mechanisms: phenazine secretion, iron competition, quorum sensing and through diffusible small molecules.
A. fumigatus
reciprocates inhibition through gliotoxin release and phenotypic adaptations enabling evasion of
P. aeruginosa
inhibition. Volatile organic compounds secreted by
P. aeruginosa
stimulate
A. fumigatus
growth, while
A. fumigatus
stimulates
P. aeruginosa
production of cytotoxic elastase.
Conclusion
A complex bi-directional relationship exists between
P. aeruginosa
and
A. fumigatus
, exhibiting both mutually antagonistic and cooperative facets. Cross-sectional data indicate a worsened disease state in coinfected patients; however, robust longitudinal studies are required to derive causality and to determine whether interspecies interaction contributes to disease progression. |
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Bibliography: | ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-3 content type line 23 ObjectType-Review-1 |
ISSN: | 0905-9180 1600-0617 |
DOI: | 10.1183/16000617.0011-2020 |