Towards standardization for mycological examination of sputum samples from Cystic Fibrosis patients: From the French multicenter experience to an international study

Introduction: Prognosis of cystic fibrosis (CF) essentially depends on impairment of the lung function. While considerable attention therefore has been paid over recent decades to the prevention and treatment of bacterial respiratory infections, leading to a marked increase in life expectancy of the patients, prevalence of colonization of the airways by filamentous fungi or yeasts, sometimes leading to true respiratory infections, has been regularly increasing. However, recently, Borman et al. (2010) reported wide variations in the range of the causative fungal pathogens and in their prevalence, related at least to a lack of standardization in the methods used to detect these microorganisms. Here, our aims are: to analyze the impact of the culture conditions used on the detection of specific fungal pathogens throughout the French multicenter experience, and to discuss the methods used in various European or Australian laboratories, in order to carry out an international prospective study that will make possible a standardized protocol for efficient detection of the whole fungal biota that can be encountered in respiratory secretions of CF patients. Results: First, from January 2007 to the end of 2009, a multicenter study was conducted in France encompassing 7 university or general hospitals which agreed to use the same procedure for mycological analysis of sputum saples from CF patients, including prior digestion of the sample with dithiolbutane and inoculation of the digested sample on 6 semi- selective agar-based media ("MucoFong" study – PHRC1902). Data obtained during one year were analyzed using the CHAID (Chi-squared Automatic Interaction Detector) method, which is a statistical approach able to give best association of media to detect a specific pathogen. CHAID is a type of decision tree technique, based upon adjusted significance testing that we apply to our data in order to define the best set of semi-selective media able to isolate 99.99% of the fungal pathogens that were detected in our CF population. Second, the major data of the international survey will be presented, and discussed with the purpose of developing a standardized approach for mycological examination of respiratory secretions from CF patients. Conclusion: Defining the optimal method for mycological analysis of the fungal components of CF lungs microbiome through a large international study is becoming a major requirement. This will make possible not only to analyze the role of some "rare" filamentous species in CF exacerbation or the existence of geographic variations in the fungal species that colonize the airways, but also to study the complexity of the CF lung microbiome as well as its dynamics

Fungal colonization in Cystic Fibrosis (CF): Epidemiology and antifungal resistance in a French cohort of CF patients – Focused on Aspergillus fumigatus colonization

Introduction: Cystic fibrosis (CF) is the major genetic inherited disease in the European Caucasian population, with an average of 1 in 3000 living births in France. Prognostic depend essentially on the lung impairments. While considerable attention therefore has been paid over recent decades to prevent and treat bacterial respiratory infections, we observed emergence of fungi colonization in CF respiratory tract. In particular, Aspergillus fumigatus represents the most common causative agent colonizing the airways of CF patients; it can be responsible for Allergic Bronchopulmonary Aspergillosis (ABPA). Since oral corticosteroids and itraconazole represent the mainstay of ABPA treatment, long-term therapy may increase the risk of acquired resistance to azoles that is mainly associated with amino acid substitutions in the CYP51A gene of A. fumigatus. Objective: First, we managed to have exhaustive epidemiological data on species of filamentous fungi able to colonize the airway tract of 300 CF patients followed-up in our national prospective study ("MucoFong" study – PHRC1902). Second, CF patients being chronically exposed to azole (especially to itraconazole), our study aimed to evaluate the prevalence of azole resistance in isolates prospectively collected from CF patients followed-up in seven French hospitals involved in our national prospective study. Third, we focused on the most prevalent species: Aspergillus fumigatus, studying the azole resistance at molecular level. To our knowledge, it is the first multicenter study focused on azole resistance of A. fumigatus in CF. Methods: A total of 243 sputa were analyzed using the same protocol in each centre. The MICs of antifungal drugs were evaluated for each isolate using the E-test ® strips. Focusing on A. fumigatus, a total of 87 isolates was collected in 85 patients. These isolates were characterized at the molecular level by targeting ITS, ß-tubulin and MAT-A/α genes. The CYP51A gene as well as its promoter was sequenced; a 3D Cyp51A protein homology model was built. Results and discussion: 300 patients were enrolled in this study. At inclusion time, most of them were adults colonized with A. fumigatus (about 35% of the patients). Scedosporium was isolated in 5%, and Exophiala in about 2%. Regarding antifungal susceptibility, isolates of Scedosporium and Exophiala exhibited antifungal resistance comparable with published data. Regarding A. fumigatus, a majority of isolates (88.1%) were found sensitive to itraconazole (MIC≤ 2μg/ml), and 2 new mutations were identified and localized within 3-dimensional Cyp51A protein model. To obtain insight into azole resistance of A. fumigatus, the results are analyzed taking into account clinical data, itraconazole exposition, and the potential correlation between the identified CYP5IA mutations and azole resistance is discussed based on the Cyp51A protein homology model

Draft Genome Sequence of the Pathogenic Fungus Scedosporium apiospermum

This is the final version of the article. Available from the publisher via the DOI in this record.The first genome of one species of the Scedosporium apiospermum complex, responsible for localized to severe disseminated infections according to the immune status of the host, will contribute to a better understanding of the pathogenicity of these fungi and also to the discovery of the mechanisms underlying their low susceptibility to current antifungals.This work was supported by a grant (RF20120600725) from the association Vaincre la Mucoviscidose (France), which is gratefully acknowledged

A Carbon Nanofilament-Bead Necklace

Carbon nanofilaments with carbon beads grown on their surfaces were successfully synthesized reproducibly by a floating catalyst CVD method. The nanofilaments hosting the pearl-like structures typically show an average diameter of about 60 nm, which mostly consists of low-ordered graphite layers. The beads with diameter range 150−450 nm are composed of hundreds of crumpled and random graphite layers. The mechanism for the formation of these beaded nanofilaments is ascribed to two nucleation processes of the pyrolytic carbon deposition, arising from a temperature gradient between different parts of the reaction chamber. Furthermore, the Raman scattering properties of the beaded nanofilaments have been measured, as well as their confocal Raman G-line images. The Raman spectra reveal that that the trunks of the nanofilaments have better graphitic properties than the beads, which is consistent with the HRTEM analysis. The beaded nanofilaments are expected to have high potential applications in composites, which should exhibit both particle- and fiber-reinforcing functions for the host matrixes

Pneumocystis jirovecii colonization among cystic fibrosis patients: A French prospective multicenter study

Pneumocystis carriage was detected in 12.5% of 104 cystic fibrosis (CF) patients during a prospective multicenter French study, with a prevalence of genotype 85C/248C and geographic variations. It was significantly associated with the absence of P. aeruginosa colonization and better FEV1 values. Results are discussed considering the natural history of CF

What can be learned from phenotyping and genotyping analyses of Scedosporium prolificans isolates from diverse origins?

Introduction: Scedosporium prolificans is a filamentous fungus considered as an emerging opportunistic member of the order Microascaceae. This fungus has a broad clinical spectrum and can cause different types of infections: localized colonization in immunocompetent hosts or disseminated mycosis in immunocompromised patients. Moreover, S. prolificans resistance to most antifungal agents has been reported. Compared to the well characterized Scedosporium / Pseudallescheria complex, little is known about the fundamental aspects of S. prolificans biology, pathogenicity and epidemiology. Aim of the study: Our goal was to characterize a large population of S. prolificans strains, isolated from animals, human, or environment samples in different countries (European, USA and Australia). Results & methods: All strains were prospectively collected, and grown at 30# C on Sabouraud’s agar medium with kanamycin for 1 week. DNA was extracted from subcultures using UltraClean Fecal# DNA kit (MoBio, France). To improve the knowledge of this species at the phylogenetic level, we combined phenotypic criteria such as macroscopic and microscopic morphology features, antifungal susceptibilities based on E-test# method, and genotypic characterization using multi-loci approaches (superoxide dismutase, beta-tubulin and internal transcript spacer genes). Phylogenetic trees were constructed with unambiguously CLUSTALW aligned sequences using the neighbour-joining method with Kimura-2 parameter as substitution model and maximum parsimony analysis, using the BioEdit version 7.0.0 and Phylip version 2.0 softwares. Discussion: Among our collection composed of 59 isolates, we identified three macroscopically different morphotypes of S. prolificans and some genetic polymorphisms (1.8–2.2% difference between the analyzed sequences). These low sequence polymorphisms reflected intra-specific genetic variations. Therefore, we hypothesized that S. prolificans might be stable in space, and apparently insensitive to xenical or environmental factors. No correlation between clinical-biological characteristics and genotypic or phenotypic criteria of S. prolificans strains was found. In conclusion, our results supported the current perception of S. prolificans as a unique species and an emerging opportunistic pathogen

Proposed nomenclature for Pseudallescheria, Scedosporium and related genera

As a result of fundamental changes in the International Code of Nomenclature on the use of separate names for sexual and asexual stages of fungi, generic names of many groups should be reconsidered. Members of the ECMM/ISHAM working group on Pseudallescheria/Scedosporium infections herein advocate a novel nomenclature for genera and species in Pseudallescheria, Scedosporium and allied taxa. The generic names Parascedosporium, Lomentospora, Petriella, Petriellopsis, and Scedosporium are proposed for a lineage within Microascaceae with mostly Scedosporium anamorphs producing slimy, annellidic conidia. Considering that Scedosporium has priority over Pseudallescheria and that Scedosporium prolificans is phylogenetically distinct from the other Scedosporium species, some name changes are proposed. Pseudallescheria minutispora and Petriellidium desertorum are renamed as Scedosporium minutisporum and S. desertorum, respectively. Scedosporium prolificans is renamed as Lomentospora prolificans

Evaluation and mangement of fungal risk in cystic fibrosis: first results of a national French study

Date du colloque&nbsp;: 06/2009</p