Chest
Original ResearchCystic FibrosisSputum Candida albicans Presages FEV1 Decline and Hospital-Treated Exacerbations in Cystic Fibrosis
Section snippets
Study Population, Study Period, and Data Collection
A prospective observational study of all patients with CF (confirmed by sweat testing and genotyping) attending our tertiary referral center between January 1998 and December 2008 (11-year period) was performed (N = 89). No exclusion criteria were adopted. Informed consent was obtained from participants and ethical approval from our institutional review board. The presence and frequency of C albicans from sputum culture were recorded. BMI, FEV1, and hospital-treated exacerbations were followed
Study Population Demographics
All demographics are summarized in Table 3. During the study period, 15 patients died, and no patient received a lung transplantation. The F508del homozygous genotype was found at higher frequencies in patients chronically colonized. Four patients (two each from the intermittent and chronic subgroups) had exposure to itraconazole during the study and for no longer than a 6-week period.
Rates of C albicans Colonization
Almost two-thirds (n = 54, 60.7%) of the patients grew C albicans during the study. However, 10 (11.2%) were
Discussion
To our knowledge, this study provides the first suggestion of a pathogenic potential for C albicans in the CF airway, illustrating the delicate balance between commensalism and pathogenicity. We detected high rates of organism isolation and colonization, which may vary among studies because of different culture techniques and the strict criteria we adopted to define colonization.8, 9, 10, 19 Defining a phenotype for airway colonization by C albicans is challenging because the organism is
Acknowledgments
Author contributions: Dr Chotirmall: contributed to the data collection, data analysis, and the writing of the manuscript.
Dr O'Donoghue: contributed to the data collection.
Dr Bennett: contributed to the data analysis.
Dr Gunaratnam: contributed to the data collection.
Dr O'Neill: contributed to the data collection.
Dr McElvaney: contributed to the data collection and the writing of the manuscript.
Financial/nonfinancial disclosure: The authors have reported to CHEST that no potential conflicts of
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