Changing Prevalence of Lower Airway Infections in Young Children with Cystic Fibrosis

Aspergillus is a type of fungus that is found everywhere in the environment. We have known for some time that Aspergillus can colonise the airways in CF in much the same way as Pseudomonas and other bacteria. Many believe that Aspergillus has “emerged” as a problem organism through the use of antibiotics. In this paper we describe the frequency that we isolate organisms in the AREST CF early surveillance program. Surprisingly Aspergillus is now the commonest organism that we observe in children under 6 years of age. Rather than “emerging” the frequency of isolation has remained the same over 20 years. However, the prevalence of other organisms has fallen. We believe that this is due to the fact that there are specific antibiotics that we use to treat infections with bacteria but we do not routinely treat Aspergillus when isolated from the airways.  Our challenge now is to understand whether this fungus plays a role in early lung damage and if so how best to treat it. 

This research being undertaken by the AREST CF program is unique and world-leading as it is one of the only studies of its kind that involves looking at airway infections in children at such an early age. 

Authors: Oded Breuer, Andre Schultz, Lidija Turkovic, Nicholas de Klerk, Anthony D. Keil, Siobhain Brennan, Joanne Harrison, Colin Robertson, Philip J. Robinson, Peter D. Sly, Sarath Ranganathan, Stephen M. Stick and Daan Caudri on behalf of AREST CF.

Published in the American Journal of Respiratory and Critical Care Medicine in September 2019.