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Aspergillus sensitization or carriage in cystic fibrosis patients.
[allergic bronchopulmonary aspergillosis]
Aspergillus
fumigatus
(
Af
)
sensitization
and
persistent
carriage
are
deleterious
to
lung
function
,
but
no
consensus
has
been
reached
defining
these
medical
entities
.
This
work
aimed
to
identify
possible
predictive
factors
for
patients
who
become
sensitized
to
Af
,
compared
with
a
control
group
of
non-sensitized
Af
carriers
.
Between
1995
and
2007
,
117
pediatric
patients
were
evaluated
.
Demographic
data
,
CFTR
gene
mutations
,
body
mass
index
and
FEV
1
were
recorded
.
The
presence
of
Af
in
sputum
,
the
levels
of
Af-precipitin
,
total
IgE
(
t-
IgE
)
and
specific
IgE
to
Af
(
Af-
IgE
)
were
determined
.
Patients
were
divided
into
2
groups
:
(
1
)
"
sensitization
"
:
level
of
Af-
IgE
>
0
.
35
IU
/
mL
with
t-
IgE
level
<
500
IU
/
mL
and
(
2
)
"
persistent
or
transient
carriage
"
:
Af-
IgE
level
≤
0
.
35
IU
/
mL
with
either
an
Af
transient
or
persistent
positive
culture
.
A
survival
analysis
was
performed
with
the
appearance
of
Af-
IgE
in
serum
as
an
outcome
variable
.
Severe
mutation
(
hazard
ratio
=
3
.
2
)
,
FEV
1
baseline
over
70
%
of
theoretical
value
(
hazard
ratio
=
4
.
9
)
,
absence
of
Pa
colonization
,
catalase
activity
and
previous
azithromycin
administration
(
hazard
ratio
=
9
.
8
,
4
.
1
and
1
.
9
,
respectively
)
were
predictive
factors
for
sensitization
.
We
propose
a
timeline
of
the
biological
events
and
a
tree
diagram
for
risk
calculation
.
Two
profiles
of
cystic
fibrosis
patients
can
be
envisaged
:
(
1
)
patients
with
nonsevere
mutation
but
low
FEV
1
baselines
are
becoming
colonized
with
Af
or
(
2
)
patients
with
high
FEV
1
baselines
who
present
with
severe
mutation
are
more
susceptible
to
the
Af
sensitization
and
then
to
the
presentation
of
an
allergic
bronchopulmonary
aspergillosis
event
.
Diseases
Validation
Diseases presenting
"lung function"
symptom
allergic bronchopulmonary aspergillosis
congenital diaphragmatic hernia
lymphangioleiomyomatosis
monosomy 21
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