Wednesday, 6 October 2010

Aspergillus is found to be the predominant organism in a group of paediatric Cystic fibrosis patients

Patients with cystic fibrosis are often susceptible to lung infections. Fibreoptic bronchoscopy (FB) and bronchoalveolar lavage (BAL) are often performed to aid the management of children with cystic fibrosis (CF). A study of a group of CF children ages 0-18 who had FB between 2005-8 in the NE of England, has revealed that 16 out of 45 patients tested positive for Aspergillus fumigatus - either in isolation or in combination with other organisms.
Other organisms such as pseudomonas aeruginosa and haemophilus influenza were isolated from some samples but Aspergillus was the most prevalent organism identified in BAL from these children. Of interest half of those with Aspergillus were also diagnosed with ABPA. (Report from the recent 20th ERS meeting, Davidson et al).
Cystic fibrosis patients generally have a poor response to the antifungal drug itraconazole (and posaconazole) - in part because they lack pancreatic enzymes necessary to absorb fats which are also required for itraconazole absorption; also because CF patients may need to take antacid medicines - acid helps to allow absorption of itraconazole.

A second report from the 20th ERS meeting has studied the pharmacokinetics of oral voriconazole in adult CF patients (Clifton et al ). They showed by monitoring blood levels of voriconazole that the drug was absorbed by the CF patients and blood levels achieved were sufficient for treatment of aspergillus. Two patients had to withdraw due to drug side effects - but they were shown to have high levels of the drug in their blood- underpinning the need to monitor antifungal drug levels for optimal effectiveness.
The study shows that voriconazole can be absorbed by CF patients and may be useful in the treatment of fungal infections in cystic fibrosis.

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