Developing collaborative works for faster progress on fungal respiratory infections in cystic fibrosis.

Cystic fibrosis (CF) is the major genetic inherited disease in Caucasian populations. The respiratory tract of CF patients displays a sticky viscous mucus, which allows for the entrapment of airborne bacteria and fungal spores and provides a suitable environment for growth of microorganisms, including numerous yeast and filamentous fungal species. As a consequence, respiratory infections are the major cause of morbidity and mortality in this clinical context. Although bacteria remain the most common agents of these infections, fungal respiratory infections have emerged as an important cause of disease. Therefore, the International Society for Human and Animal Mycology (ISHAM) has launched a working group on Fungal respiratory infections in Cystic Fibrosis (Fri-CF) in October 2006, which was subsequently approved by the European Confederation of Medical Mycology (ECMM). Meetings of this working group, comprising both clinicians and mycologists involved in the follow-up of CF patients, as well as basic scientists interested in the fungal species involved, provided the opportunity to initiate collaborative works aimed to improve our knowledge on these infections to assist clinicians in patient management. The current review highlights the outcomes of some of these collaborative works in clinical surveillance, pathogenesis and treatment, giving special emphasis to standardization of culture procedures, improvement of species identification methods including the development of nonculture-based diagnostic methods, microbiome studies and identification of new biological markers, and the description of genotyping studies aiming to differentiate transient carriage and chronic colonization of the airways. The review also reports on the breakthrough in sequencing the genomes of the main Scedosporium species as basis for a better understanding of the pathogenic mechanisms of these fungi, and discusses treatment options of infections caused by multidrug resistant microorganisms, such as Scedosporium and Lomentospora species and members of the Rasamsonia argillacea species complex.

[Microbiological aspects of the cryptococcosis in the post-HAART era]. / Aspectos microbiológicos de la criptococosis en la era post-TARGA.

Cryptococcosis is a mycoses that increased considerably with the AIDS epidemic. However, with the introduction in the late 90's of the highly active antiretroviral therapy (HAART), this incidence has significantly decreased, especially in developed countries, in contrast with that of developing countries. The introduction of HAART not only has affected the incidence rate, but also the clinical presentation as a consequence of the immune recovery of the host, leading to the description of the so called immune reconstitution inflammatory syndrome. In addition, some rare clinical manifestations of cyptococcosis are currently shown, such as lymphadenitis and cutaneous involvement. Besides clinical presentation, diagnostic tests have also changed, with a high percentage of cases with negative cerebrospinal fluid (CSF) and blood cultures, negative direct CSF microscopy, and delayed antigen positive results. Antifungal susceptibility patterns have also changed towards a recuperation of susceptibility, which is related to the decrease in both the incidence of cryptococcosis and less use of antifungal agents.