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1.
BMJ Case Rep ; 12(10)2019 Oct 05.
Artigo em Inglês | MEDLINE | ID: mdl-31586955

RESUMO

Flexible bronchoscopy is a commonly performed procedure in pulmonary medicine. The common complications following bronchoscopy include minor bleeding, transient hypoxaemia, pneumothorax and others. Pneumothorax during diagnostic flexible bronchoscopy is mainly encountered after performing transbronchial lung biopsy. Iatrogenic pneumothorax is uncommon when lung biopsy is not performed. Herein, we report the unusual occurrence of pneumothorax following bronchoscopic suctioning while removing a mucus plug.


Assuntos
Aspergillus fumigatus/isolamento & purificação , Biópsia por Agulha/efeitos adversos , Broncoscopia/efeitos adversos , Pneumotórax/etiologia , Aspergilose Pulmonar/diagnóstico , Adulto , Diagnóstico Diferencial , Feminino , Humanos , Doença Iatrogênica , Muco , Aspergilose Pulmonar/patologia , Sucção/efeitos adversos
2.
BMJ Case Rep ; 12(5)2019 May 08.
Artigo em Inglês | MEDLINE | ID: mdl-31068343

RESUMO

A 64-year-old manpresented with non-productive cough and dyspnoea and was evaluated and diagnosed to have a left lung mass on CT of the chest. A transthoracic needle biopsy under CT guidance revealed necrotic tissue on histopathology and was inconclusive. Positron emission tomography scan revealed a fluoro-deoxyglucose-avid left lung mass with a left upper lobe luminal cut-off. A flexible video bronchoscopy was performed and revealed left upper lobe complete obstruction with an endoluminal plug which was removed in piecemeal fashion, and deeper biopsies were taken from the lingula. Histopathology revealed underlying adenocarcinoma colonised by aspergillosis. This case serves to remind us of the possibility of missing underlying malignancy when taking superficial biopsies of clearly visualised endobronchial necrotic tissue and the need for debulking it to a reasonable extent and to take deeper biopsies in order to not miss a possible underlying malignancy.


Assuntos
Adenocarcinoma/patologia , Broncoscopia/instrumentação , Dispneia/patologia , Biópsia Guiada por Imagem , Neoplasias Pulmonares/patologia , Tomografia por Emissão de Pósitrons , Aspergilose Pulmonar/patologia , Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma/terapia , Biópsia por Agulha , Tosse , Dispneia/diagnóstico por imagem , Dispneia/microbiologia , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/microbiologia , Masculino , Pessoa de Meia-Idade , Pneumonectomia , Aspergilose Pulmonar/diagnóstico por imagem , Aspergilose Pulmonar/terapia , Recusa do Paciente ao Tratamento
3.
Surg Laparosc Endosc Percutan Tech ; 29(4): e37-e40, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31083021

RESUMO

Pulmonary aspergilloma is an uncommon pulmonary disease that complicated with many other respiratory disorders. Despite advances in medication, surgical treatment continues to form the basis of aspergilloma treatment. However, the use of uniportal video-assisted thoracoscopic surgery is extremely limited in pulmonary aspergilloma. In this report, 5 patients who underwent anatomic pulmonary resection safely with uniportal video-assisted thoracoscopic surgery technique without requiring a traditional thoracotomy were presented.


Assuntos
Pneumonectomia/métodos , Aspergilose Pulmonar/diagnóstico por imagem , Aspergilose Pulmonar/cirurgia , Cirurgia Torácica Vídeoassistida/métodos , Adulto , Idoso , Biópsia por Agulha , Feminino , Seguimentos , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Cuidados Pré-Operatórios/métodos , Aspergilose Pulmonar/patologia , Estudos Retrospectivos , Amostragem , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
4.
Med Mycol ; 57(Supplement_2): S189-S195, 2019 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-30816972

RESUMO

Aspergillus moulds are increasingly being recognised as significant human pathogens that can cause life-threatening infections in the context of host immune dysregulation, particularly in the lung. It is now clear that there is a close relationship between infection susceptibility and the fine regulation of pulmonary immunity and inflammation. While the contribution of IL-17/Th17 responses to both physiological and pathological lung inflammation is now well established, the cellular interactions, soluble factors, and signalling pathways that determine Th17 cell responses to fungal infection remain unclear. Here, we identify potential key mediators of fungus-DC-T cell interactions in the respiratory tract, with a focus on the DC-derived cytokines thought to exert a major influence on generation of pathological Th17 cells. We review recent data indicating a crucial role for Aspergillus-induced autophagy in lung DCs on subsequent T-cell polarization and modulation of 'stemness', which appears critical for avoiding pathological lung inflammation and promoting disease resolution.


Assuntos
Aspergillus/imunologia , Aspergillus/patogenicidade , Células Dendríticas/imunologia , Interações Hospedeiro-Patógeno , Aspergilose Pulmonar/tratamento farmacológico , Aspergilose Pulmonar/patologia , Células Th17/imunologia , Animais , Autofagia , Citocinas/metabolismo , Modelos Animais de Doenças , Humanos
5.
Med Mycol ; 57(Supplement_2): S118-S126, 2019 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-30816976

RESUMO

Cystic fibrosis (CF), caused by mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene, is the most common inherited life-limiting disease in North European people affecting 90,000 people worldwide. Progressive lung damage caused by recurrent infection and chronic airway inflammation is the major determinant of survival with a median age at death of 29 years. Approximately 60% of CF patients are infected with Aspergillus fumigatus, a ubiquitous environmental fungus, and its presence has been associated with accelerated lung function decline. Half of the patients infected with Aspergillus are <18 years of age. Yet time of acquisition of this fungus and determinants of CF-related Aspergillus disease severity and progression are not known. CFTR expression has been demonstrated in cells of the innate and adaptive immune system and has shown to be critical for normal function. Research delineating the role of CFTR-deficient phagocytes in Aspergillus persistence and infection in the CF lung, has only recently received attention. In this concise review we aim to present the current understanding with respect to when people with CF acquire infection with A. fumigatus and antifungal immune responses by CF immune cells.


Assuntos
Aspergillus fumigatus/imunologia , Fibrose Cística/complicações , Imunidade Inata , Leucócitos/imunologia , Aspergilose Pulmonar/imunologia , Aspergilose Pulmonar/patologia , Regulador de Condutância Transmembrana em Fibrose Cística/deficiência , Humanos
6.
Med Mycol ; 57(Supplement_2): S219-S227, 2019 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-30239804

RESUMO

Aspergillus colonization of the lower respiratory airways is common in normal people, and of little clinical significance. However, in some patients, colonization is associated with severe disease including poorly controlled asthma, allergic bronchopulmonary aspergillosis (ABPA) with sputum plugs, worse lung function in chronic obstructive pulmonary aspergillosis (COPD), invasive aspergillosis, and active infection in patients with chronic pulmonary aspergillosis (CPA). Therefore, understanding the pathophysiological mechanisms of fungal colonization in disease is essential to develop strategies to avert or minimise disease. Aspergillus cell components promoting fungal adherence to the host surface, extracellular matrix, or basal lamina are indispensable for pathogen persistence. However, our understanding of individual differences in clearance of A. fumigatus from the lung in susceptible patients is close to zero.


Assuntos
Aspergillus/crescimento & desenvolvimento , Interações Hospedeiro-Patógeno , Aspergilose Pulmonar/patologia , Aspergilose Pulmonar/fisiopatologia , Animais , Modelos Animais de Doenças , Humanos , Modelos Biológicos
7.
ACS Appl Mater Interfaces ; 11(1): 104-114, 2019 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-30560648

RESUMO

Fungal infections are a growing global health and agricultural threat, and current chemical antifungals may induce various side-effects. Thus, nanoparticles are investigated as potential novel antifungals. We report that nanoparticles' antifungal activity strongly depends on their binding to fungal spores, focusing on the clinically important fungal pathogen Aspergillus fumigatus as well as common plant pathogens, such as Botrytis cinerea. We show that nanoparticle-spore complex formation was enhanced by the small nanoparticle size rather than the material, shape or charge, and could not be prevented by steric surface modifications. Fungal resistance to metal-based nanoparticles, such as ZnO-, Ag-, or CuO-nanoparticles as well as dissolution-resistant quantum dots, was mediated by biomolecule coronas acquired in pathophysiological and ecological environments, including the lung surfactant, plasma or complex organic matters. Mechanistically, dose-dependent corona-mediated resistance occurred via reducing physical adsorption of nanoparticles to fungal spores. The inhibitory effect of biomolecules on the antifungal activity of Ag-nanoparticles was further verified in vivo, using the invertebrate Galleria mellonella as an A. fumigatus infection model. Our results explain why current nanoantifungals often show low activity in realistic application environments, and will guide nanomaterial designs that maximize functionality and safe translatability as potent antifungals for human health, biotechnology, and agriculture.


Assuntos
Antifúngicos , Aspergillus fumigatus/crescimento & desenvolvimento , Farmacorresistência Fúngica/efeitos dos fármacos , Nanopartículas Metálicas , Coroa de Proteína/química , Animais , Antifúngicos/química , Antifúngicos/farmacologia , Botrytis , Modelos Animais de Doenças , Humanos , Nanopartículas Metálicas/química , Nanopartículas Metálicas/uso terapêutico , Camundongos , Mariposas , Doenças das Plantas , Aspergilose Pulmonar/tratamento farmacológico , Aspergilose Pulmonar/metabolismo , Aspergilose Pulmonar/patologia
9.
Clin Radiol ; 73(11): 913-921, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30075854

RESUMO

Pulmonary syndromes following exposure to Aspergillus sp. have a variety of clinical and radiological manifestations. The radiological manifestations mirror the pathophysiological response to Aspergillus sp., which is linked closely to the patient's immune status. The plethora of terms in the literature can be confusing and their application with relevance to radiological imaging may subsequently result in inadequate or non-specific classification. In this review, we aim to provide a simplified and up-to-date approach to the recognition of the imaging manifestations of pulmonary aspergillosis, using correlation with histopathological and clinical descriptors. This will enable the radiologist to utilise the imaging findings to instigate clinically useful and appropriate management for those patients at risk of significant morbidity and mortality.


Assuntos
Aspergilose Pulmonar/patologia , Humanos , Pulmão/diagnóstico por imagem , Pulmão/microbiologia , Pulmão/patologia , Aspergilose Pulmonar/diagnóstico por imagem , Radiografia Torácica , Tomografia Computadorizada por Raios X
10.
Microbiology ; 164(8): 1009-1011, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-30066670

RESUMO

Aspergillus fumigatus is a saprotrophic fungus that continuously disseminates spores (conidia) into the environment. It is also the most common and opportunistic aerial fungal pathogen, causing allergic and chronic lung pathologies including the fatal invasive aspergillosis in immunocompromised patients. The pathobiology of aspergillosis is complex and depends on the competence of the host immune system. Moreover, A. fumigatus has become a model to study unique features of fungi. This includes the fungal cell wall, which not only acts as a rigid skeleton for protection against hostile environments but also plays significant roles during infection by manipulating the host immune response.


Assuntos
Aspergillus fumigatus/patogenicidade , Aspergilose Pulmonar/patologia , Esporos Fúngicos/crescimento & desenvolvimento , Aspergillus fumigatus/genética , Aspergillus fumigatus/crescimento & desenvolvimento , Genoma Fúngico/genética , Micélio/crescimento & desenvolvimento , Filogenia
11.
Emerg Infect Dis ; 24(8)2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-30016256

RESUMO

Chronic pulmonary aspergillosis (CPA) is a recognized complication of pulmonary tuberculosis (TB). In 2015, the World Health Organization reported 2.2 million new cases of nonbacteriologically confirmed pulmonary TB; some of these patients probably had undiagnosed CPA. In October 2016, the Global Action Fund for Fungal Infections convened an international expert panel to develop a case definition of CPA for resource-constrained settings. This panel defined CPA as illness for >3 months and all of the following: 1) weight loss, persistent cough, and/or hemoptysis; 2) chest images showing progressive cavitary infiltrates and/or a fungal ball and/or pericavitary fibrosis or infiltrates or pleural thickening; and 3) a positive Aspergillus IgG assay result or other evidence of Aspergillus infection. The proposed definition will facilitate advancements in research, practice, and policy in lower- and middle-income countries as well as in resource-constrained settings.


Assuntos
Aspergilose Pulmonar/diagnóstico , Aspergilose Pulmonar/patologia , Doença Crônica , Países em Desenvolvimento , Humanos , Guias de Prática Clínica como Assunto , Aspergilose Pulmonar/microbiologia , Fatores Socioeconômicos
13.
Proc Natl Acad Sci U S A ; 115(27): 7087-7092, 2018 07 03.
Artigo em Inglês | MEDLINE | ID: mdl-29925597

RESUMO

Airborne fungal pathogens, predominantly Aspergillus fumigatus, can cause severe respiratory tract diseases. Here we show that in environments, fungal spores can already be decorated with nanoparticles. Using representative controlled nanoparticle models, we demonstrate that various nanoparticles, but not microparticles, rapidly and stably associate with spores, without specific functionalization. Nanoparticle-spore complex formation was enhanced by small nanoparticle size rather than by material, charge, or "stealth" modifications and was concentration-dependently reduced by the formation of environmental or physiological biomolecule coronas. Assembly of nanoparticle-spore surface hybrid structures affected their pathobiology, including reduced sensitivity against defensins, uptake into phagocytes, lung cell toxicity, and TLR/cytokine-mediated inflammatory responses. Following infection of mice, nanoparticle-spore complexes were detectable in the lung and less efficiently eliminated by the pulmonary immune defense, thereby enhancing A. fumigatus infections in immunocompromised animals. Collectively, self-assembly of nanoparticle-fungal complexes affects their (patho)biological identity, which may impact human health and ecology.


Assuntos
Aspergillus fumigatus/imunologia , Citocinas/imunologia , Pulmão/imunologia , Nanopartículas , Aspergilose Pulmonar/imunologia , Esporos Fúngicos/imunologia , Células A549 , Animais , Humanos , Pulmão/patologia , Camundongos , Coroa de Proteína/imunologia , Aspergilose Pulmonar/patologia , Células THP-1
14.
Int J Antimicrob Agents ; 52(2): 258-264, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29906567

RESUMO

OBJECTIVES: Chronic pulmonary aspergillosis (CPA) is a progressive infection that destroys lung tissue in non-immunocompromised patients. First-line therapies for CPA (itraconazole and/or voriconazole) are often curtailed due to toxicity or the development of drug resistance. Posaconazole is a potential alternative for these patients. METHODS: Use of posaconazole was funded by the National Health Service Highly Specialised National Commissioners on an individual basis for patients who failed or did not tolerate first-line therapy; those who met predefined criteria for improvement at 4 and 6 months (weight gain and/or improvement in St George's Respiratory Questionnaire) continued posaconazole long-term. We recorded response, failure, discontinuation rates, and adverse events. RESULTS: Seventy-eight patients received posaconazole as salvage therapy. Thirty-four (44%) achieved targets for continuation of therapy. Fourteen (18%) failed therapy; five (36%) patients did not achieve clinical targets at 4 or 6 months of assessment and nine (64%) developed clinical and/or radiological failure. Twenty-eight (36%) discontinued their trial early; 8 (29%) died and 20 (71%) had significant side effects. One patient was non-compliant and another was lost to follow up. CONCLUSIONS: Establishing criteria for therapeutic success offered a clear, safe and sustainable method of identifying patients who benefit from additional therapy, and minimised continuation of ineffective therapy in those who did not.


Assuntos
Antifúngicos/uso terapêutico , Aspergillus fumigatus/efeitos dos fármacos , Aspergilose Pulmonar/tratamento farmacológico , Terapia de Salvação/métodos , Triazóis/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , Aspergillus fumigatus/crescimento & desenvolvimento , Aspergillus fumigatus/patogenicidade , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Aspergilose Pulmonar/microbiologia , Aspergilose Pulmonar/mortalidade , Aspergilose Pulmonar/patologia , Estudos Retrospectivos , Inquéritos e Questionários , Análise de Sobrevida , Resultado do Tratamento
15.
Eur Radiol ; 28(10): 4053-4061, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29725831

RESUMO

OBJECTIVES: The aim of this study was to assess the CT findings that characterise haemoptysis in patients with chronic pulmonary aspergillosis (CPA). METHODS: We retrospectively identified 120 consecutive patients with CPA (84 men and 36 women, 17-89 years of age, mean age 68.4 years) who had undergone a total of 829 CT examinations between January 2007 and February 2017. In the 11 patients who underwent surgical resection, CT images were compared with the pathological results. RESULTS: The scab-like sign was seen on 142 of the 829 CT scans, specifically, in 87 of the 90 CT scans for haemoptysis and in 55 of the 739 CT scans obtained during therapy evaluation. In 48 of those 55 patients, haemoptysis occurred within 55 days (mean 12.0 days) after the CT scan. In the 687 CT scans with no scab-like sign, there were only three instances of subsequent haemoptysis in the respective patients over the following 6 months. Patients with and without scab-like sign differed significantly in the frequency of haemoptysis occurring after a CT scan (p<0.0001). Pathologically, the scab-like sign corresponded to a fibrinopurulent mass or blood crust. CONCLUSIONS: The scab-like sign should be considered as a CT finding indicative of haemoptysis. KEY POINTS: • Haemoptysis is commonly found in patients with CPA. • A CT finding indicative of haemoptysis in CPA patients is described. • Scab-like sign may identify CPA patients at higher risk of haemoptysis.


Assuntos
Hemoptise/diagnóstico por imagem , Aspergilose Pulmonar/patologia , Tomografia Computadorizada por Raios X/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Feminino , Hemoptise/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Aspergilose Pulmonar/complicações , Aspergilose Pulmonar/diagnóstico por imagem , Estudos Retrospectivos , Adulto Jovem
16.
J Wildl Dis ; 54(3): 631-634, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29498897

RESUMO

Aspergillus fumigatus is one of the most common Aspergillus species causing disease in individual animals but it rarely affects deer species. We report a case of A. fumigatus infection causing mycotic pneumonia and hypertrophic osteopathy in a roe deer ( Capreolus capreolus).


Assuntos
Cervos/microbiologia , Osteoartropatia Hipertrófica Secundária/veterinária , Aspergilose Pulmonar/veterinária , Animais , Aspergillus fumigatus/isolamento & purificação , Masculino , Osteoartropatia Hipertrófica Secundária/patologia , Aspergilose Pulmonar/patologia
17.
J Biol Chem ; 293(13): 4901-4912, 2018 03 30.
Artigo em Inglês | MEDLINE | ID: mdl-29414772

RESUMO

Surfactant protein D (SP-D), a C-type lectin and pattern-recognition soluble factor, plays an important role in immune surveillance to detect and eliminate human pulmonary pathogens. SP-D has been shown to protect against infections with the most ubiquitous airborne fungal pathogen, Aspergillus fumigatus, but the fungal surface component(s) interacting with SP-D is unknown. Here, we show that SP-D binds to melanin pigment on the surface of A. fumigatus dormant spores (conidia). SP-D also exhibited an affinity to two cell-wall polysaccharides of A. fumigatus, galactomannan (GM) and galactosaminogalactan (GAG). The immunolabeling pattern of SP-D was punctate on the conidial surface and was uniform on germinating conidia, in accordance with the localization of melanin, GM, and GAG. We also found that the collagen-like domain of SP-D is involved in its interaction with melanin, whereas its carbohydrate-recognition domain recognized GM and GAG. Unlike un-opsonized conidia, SP-D-opsonized conidia were phagocytosed more efficiently and stimulated the secretion of proinflammatory cytokines by human monocyte-derived macrophages. Furthermore, SP-D-/- mice challenged intranasally with wildtype conidia or melanin ghosts (i.e. hollow melanin spheres) displayed significantly reduced proinflammatory cytokines in the lung compared with wildtype mice. In summary, SP-D binds to melanin present on the dormant A. fumigatus conidial surface, facilitates conidial phagocytosis, and stimulates the host immune response.


Assuntos
Aspergillus fumigatus/imunologia , Polissacarídeos Fúngicos/imunologia , Melaninas/imunologia , Fagocitose , Aspergilose Pulmonar/imunologia , Proteína D Associada a Surfactante Pulmonar/imunologia , Esporos Fúngicos/imunologia , Animais , Aspergillus fumigatus/genética , Polissacarídeos Fúngicos/genética , Melaninas/genética , Camundongos , Camundongos Knockout , Aspergilose Pulmonar/genética , Aspergilose Pulmonar/patologia , Proteína D Associada a Surfactante Pulmonar/genética , Esporos Fúngicos/genética
19.
Mycopathologia ; 183(2): 337-348, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29058172

RESUMO

BACKGROUND: C-type lectin receptors (CLRs), Toll-like receptors (TLRs), and Nod-like receptors (NLRs) have the ability to recognize Aspergillus fumigatus (A. fumigates) and induce innate immune response. Dectin-1 is a well-described CLR, while interleukin-1 receptor-associated kinase 1 (Irak1) and receptor-interacting protein 2 (Rip2) are pivotal adaptor proteins of TLRs and NLRs signaling pathways, respectively. OBJECTIVES: Our primary aim is to elucidate whether Dectin-1 regulates the expression of Irak1 and Rip2, and confirm that CLRs, TLRs, and NLRs pathways act synergistically in response to A. fumigatus infection. METHODS: Pulmonary infection mouse models were established. Myeloid cells were differentiated in cell culture and examined by inverted microscopy, flow cytometry, and scanning electron microscopy. The relative mRNA levels were determined by qRT-PCR. The protein expression levels were determined by immunohistochemistry and Western blot. RESULTS: The expression of Dectin-1, Irak1, Rip2, and phosphorylation level of nuclear factor (NF)-κB p65 were induced by conidia in immunocompetent mice, while their expression and phosphorylation level were inhibited in immunocompromised mice after the administration of conidia. Conidia increased the expression of Dectin-1, Irak1, and Rip2 in myeloid cells, while Dectin-1 silencing significantly reduced their expression. CONCLUSION: Our findings demonstrate that Dectin-1, Irak1, and Rip2 are involved in response to A. fumigatus infection. Dectin-1 modulates the expression of Irak1 and Rip2. Additionally, these three signaling pathways are interconnected, and CLRs pathway plays a dominant role against A. fumigatus invasion.


Assuntos
Aspergillus fumigatus/crescimento & desenvolvimento , Interações Hospedeiro-Patógeno , Quinases Associadas a Receptores de Interleucina-1/análise , Lectinas Tipo C/análise , Aspergilose Pulmonar/patologia , Proteína Serina-Treonina Quinases de Interação com Receptores/análise , Animais , Células Cultivadas , Modelos Animais de Doenças , Perfilação da Expressão Gênica , Imuno-Histoquímica , Masculino , Camundongos Endogâmicos BALB C , Reação em Cadeia da Polimerase em Tempo Real
20.
Mycopathologia ; 183(1): 45-59, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28516246

RESUMO

Bronchiectasis is a chronic irreversible airway abnormality associated with infectious agents that either cause or superinfect the airways. While the role of bacteria is well studied, much remains to be determined about fungi in both cystic fibrosis- and non-cystic fibrosis-related bronchiectasis. The airway is constantly exposed to inhaled ambient moulds of which Aspergillus represent the most ubiquitous. In a normal healthy host, this situation is of little consequence. The presence of anatomical or immunological abnormalities such as those in bronchiectasis leads to a range of fungal-related pathologies from asymptomatic airway colonization to fungal sensitization, allergic bronchopulmonary aspergillosis or chronic pulmonary aspergillosis. These entities are difficult to recognize, diagnose and treat due in part to a lack of validated biomarkers. Our true understanding of the complex relationships that regulate fungal-host interactions is still in its infancy and, several questions remain. This includes if fungal epidemiology in bronchiectasis is uniform across countries, and to what extent immunopathological mechanisms-related to fungal airway infections-occurs in different disease states. Specific triggers to allergic or infectious responses to Aspergillus require further exploration. How transition occurs between allergic and invasive phenotypes and their respective biomarkers is also important. Whether anti-fungal treatment is warranted in all cases and what the optimal management strategy is, particularly when treatment should commence and its expected duration remains unclear. Further research is clearly necessary and should be prioritized to better understand the clinical effects and impact of Aspergillus in the setting of bronchiectasis.


Assuntos
Aspergillus/classificação , Aspergillus/isolamento & purificação , Bronquiectasia/complicações , Interações Hospedeiro-Patógeno , Aspergilose Pulmonar/patologia , Aspergilose Pulmonar/fisiopatologia , Antifúngicos/uso terapêutico , Fibrose Cística/complicações , Humanos , Aspergilose Pulmonar/tratamento farmacológico
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