Abstract
Introduction: Understanding the composition and clinical importance of the fungal mycobiome was recently identified as a key topic in a “research priorities” consensus statement for bronchiectasis Methods: Patients were recruited as part of the CAMEB study: an international multicentre cross-sectional Cohort of Asian and Matched European Bronchiectasis patients. The mycobiome was determined in 238 patients by targeted amplicon shotgun sequencing of the 18S-28S rRNA internally transcribed spacer regions ITS1 and ITS2. Specific qPCR for detection of and conidial quantification for a range of airway Aspergillus species was performed. Sputum galactomannan, Aspergillus-specific IgE, IgG and Thymus and Activation Regulated Chemokine levels were measured systemically and associated to clinical outcomes. Results: The bronchiectasis mycobiome is distinct, and characterised by specific fungal genera including Aspergillus, Cryptococcus, and Clavispora. A. fumigatus (in Singapore/Kuala Lumpur) and A. terreus (in Dundee) dominated profiles, the latter associating with exacerbations. High frequencies of Aspergillus-associated disease including sensitization and allergic bronchopulmonary aspergillosis were detected. Each revealed distinct mycobiome profiles and associated with more severe disease, poorer pulmonary function and increased exacerbations. Conclusion: The pulmonary mycobiome is of clinical relevance in bronchiectasis. Screening for Aspergillus-associated disease should be considered even in apparently stable patients.
Footnotes
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Conflict of interest: Dr. Lim has nothing to disclose.
Conflict of interest: Dr. Ng has nothing to disclose.
Conflict of interest: Dr. Martinus has nothing to disclose.
Conflict of interest: Dr. Bertrand has nothing to disclose.
Conflict of interest: Dr. Chew reports personal fees from Sime Darby Technology Center, personal fees from Olam International and First Resources Ltd., outside the submitted work.
Conflict of interest: Dr. Tan has nothing to disclose.
Conflict of interest: Dr. Keir has nothing to disclose.
Conflict of interest: Dr. Chalmers reports grants and personal fees from Glaxosmithkline, grants and personal fees from Boehringer-Ingelheim, grants from Astrazeneca, grants and personal fees from Pfizer, grants and personal fees from Bayer Healthcare, grants and personal fees from Grifols, personal fees from Napp, outside the submitted work.
Conflict of interest: Dr. Koh has nothing to disclose.
Conflict of interest: Dr. Abisheganaden has nothing to disclose.
Conflict of interest: Dr. Connolly has nothing to disclose.
Conflict of interest: Dr. Koh has nothing to disclose.
Conflict of interest: Dr. Mac Aogáin has nothing to disclose.
Conflict of interest: Dr. Nagarajan has nothing to disclose.
Conflict of interest: Dr. Chandrasekaran has nothing to disclose.
Conflict of interest: Dr. Chotirmall has nothing to disclose.
Conflict of interest: Dr. Matta has nothing to disclose.
Conflict of interest: Dr. Pang has nothing to disclose.
Conflict of interest: Dr. Low has nothing to disclose.
Conflict of interest: Dr. Ong has nothing to disclose.
Conflict of interest: Dr. Hassan has nothing to disclose.
Conflict of interest: Dr. Gwee has nothing to disclose.
Conflict of interest: Dr. Sio has nothing to disclose.
Conflict of interest: Dr. Lee has nothing to disclose.
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