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Aspergillus and cystic fibrosis: old disease - new classifications.
[allergic bronchopulmonary aspergillosis]
Aspergillus
pulmonary
infection
has
traditionally
been
recognized
as
a
clinical
spectrum
of
increasing
pathogenicity
,
encompassing
saprophytic
airways
colonization
historically
regarded
of
doubtful
clinical
significance
,
to
allergic
bronchopulmonary
aspergillosis
,
chronic
cavitatory
and
life-threatening
invasive
disease
in
the
immunocompromised
host
.
Whilst
the
latter
two
categories
are
rarely
encountered
in
cystic
fibrosis
(
CF
)
,
there
is
recognition
of
an
extending
spectrum
of
disease
yet
to
be
reflected
in
consensus
management
guidelines
.
The
purpose
of
this
review
is
to
provide
an
up-
to
-date
overview
of
this
extending
spectrum
,
with
a
focus
on
disease
categories
and
their
clinical
significance
.
Conflicting
evidence
regarding
the
clinical
significance
of
Aspergillus
colonization
and
sensitization
in
CF
,
alongside
the
emergence
of
a
novel
disease
category
'
Aspergillus
bronchitis
'
,
has
led
to
proposals
for
the
reclassification
of
Aspergillus
disease
.
In
addition
,
lack
of
standardization
and
poor
sensitivity
of
culture-dependent
mycology
techniques
renders
clinical
and
epidemiological
interpretation
of
these
isolates
challenging
.
The
role
of
Aspergillus
in
the
absence
of
established
CF
-
allergic
bronchopulmonary
aspergillosis
remains
unclear
.
The
following
review
discusses
new
approaches
proposed
to
categorise
the
extended
spectrum
of
CF
Aspergillus
disease
,
highlighting
the
need
for
enhanced
microbiological
investigation
and
serological
monitoring
of
patients
in
light
of
evidence
which
differentiates
colonization
from
categories
of
greater
pathogenic
potential
.
