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Eur Respir Rev

Title:		Coinfection with Pseudomonas aeruginosa and Aspergillus fumigatus in cystic fibrosis
Author(s):		Keown K; Reid A; Moore JE; Taggart CC; Downey DG;
Address:		"Royal Belfast Hospital for Sick Children, Belfast Health and Social Care Trust, Belfast, UK. Wellcome Wolfson Centre for Experimental Medicine, Queen's University Belfast, Belfast, UK. Northern Ireland Public Health Laboratory, Dept of Bacteriology, Belfast City Hospital, Belfast, UK. Wellcome Wolfson Centre for Experimental Medicine, Queen's University Belfast, Belfast, UK d.downey@qub.ac.uk"
Journal Title:		Eur Respir Rev
Year:		2020
Volume:		20201118
Issue:		158
Page Number:		-
DOI:		10.1183/16000617.0011-2020
ISSN/ISBN:		1600-0617 (Electronic) 0905-9180 (Print) 0905-9180 (Linking)
Abstract:		"OBJECTIVES: Cystic fibrosis (CF) lung disease is characterised by mucus stasis, chronic infection and inflammation, causing progressive structural lung disease and eventual respiratory failure. CF airways are inhabited by an ecologically diverse polymicrobial environment with vast potential for interspecies interactions, which may be a contributing factor to disease progression. Pseudomonas aeruginosa and Aspergillus fumigatus are the most common bacterial and fungal species present in CF airways respectively and coinfection results in a worse disease phenotype. METHODS: In this review we examine existing expert knowledge of chronic co-infection with P. aeruginosa and A. fumigatus in CF patients. We summarise the mechanisms of interaction and evaluate the clinical and inflammatory impacts of this co-infection. RESULTS: P. aeruginosa inhibits A. fumigatus through multiple mechanisms: phenazine secretion, iron competition, quorum sensing and through diffusible small molecules. A. fumigatus reciprocates inhibition through gliotoxin release and phenotypic adaptations enabling evasion of P. aeruginosa inhibition. Volatile organic compounds secreted by P. aeruginosa stimulate A. fumigatus growth, while A. fumigatus stimulates P. aeruginosa production of cytotoxic elastase. CONCLUSION: A complex bi-directional relationship exists between P. aeruginosa and A. fumigatus, exhibiting both mutually antagonistic and cooperative facets. Cross-sectional data indicate a worsened disease state in coinfected patients; however, robust longitudinal studies are required to derive causality and to determine whether interspecies interaction contributes to disease progression"
Keywords:		Aspergillus fumigatus *Coinfection Cross-Sectional Studies *Cystic Fibrosis/complications/diagnosis Humans Pseudomonas aeruginosa;
Notes:		"MedlineKeown, Karen Reid, Alastair Moore, John E Taggart, Clifford C Downey, Damian G eng Review England 2020/11/20 Eur Respir Rev. 2020 Nov 18; 29(158):200011. doi: 10.1183/16000617.0011-2020. Print 2020 Dec 31"