The relationship between fungal culture (FC) positivity and airway inflammation in CF is largely unknown. Identifying the clinical significance of filamentous fungi in CF using both clinical parameters and biomarkers may change our antimicrobial therapeutic strategies.

To investigate the clinical characteristics and airway biomarker profile in relation to the detection of filamentous fungi in respiratory samples obtained from CF patients.

A prospective cohort study over 24 months, including children and adults with CF. Participants provided sputum and/or bronchoalveolar lavage samples, which underwent processing for bacterial and fungal culture, leukocyte differential cell count and biomarker analysis for neutrophil elastase (NE), interleukin-8 (IL-8), galactomannan and tumor necrosis factor receptor type 2 (TNF-R2). We performed FC using neat sputum plugs, an approach shown to be more sensitive compared to routine laboratory testing.

Sixty-one patients provided 76 respiratory samples (72 sputum and 4 BAL). Median age was 17 years (range 6 months–59 years). FC positivity was noted in 49% of the cohort. FC positivity was greater during pulmonary exacerbation compared to the stable state (67 versus 50%). Participants aged 5–30 years had a lower FEV1 within the FC positive group. A significant association between FC positivity and non-tuberculosis mycobacterial (NTM) culture was observed on non-parametric testing (p = 0.022) and regression analysis (p = 0.007). Exposure to indoor mold was a predictor for FC positivity (p = 0.047). There was a trend towards increased lung clearance index (LCI), bronchiectasis and intravenous antibiotic use in the FC positive group. There was no significant difference in biomarkers between FC positive and negative patients.

Aspergillus. fumigatus is the commonest filamentous fungi cultured from CF airways. We found no difference in the airway biomarker profile between FC positive and negative patients. The role of galactomannan and TNFR2 as fungal specific biomarkers in CF remains uncertain. FC positivity is associated with a lower FEV₁ in younger patients, a lower LCI, NTM positivity, bronchiectasis, and intravenous antibiotic exposure. Larger trials are needed to determine the role of galactomannan and TNF-R2 as potential fungal biomarkers in CF.

CF中真菌培养（FC）阳性与气道炎症之间的关系尚不清楚。使用临床参数和生物标记物鉴定CF中丝状真菌的临床意义可能会改变我们的抗菌治疗策略。

调查与从CF患者获得的呼吸道样本中丝状真菌的检测有关的临床特征和气道生物标志物谱。

一项为期24个月的前瞻性队列研究，包括儿童和成人CF。参与者提供了痰和/或支气管肺泡灌洗样品，这些样品经过了细菌和真菌培养，白细胞分化细胞计数和中性粒细胞弹性蛋白酶（NE），白细胞介素-8（IL-8），半乳甘露聚糖和2型肿瘤坏死因子受体的生物标志物分析处理。 （TNF-R2）。我们使用纯净的痰液塞进行FC，与常规实验室测试相比，该方法显示出更高的敏感性。

61位患者提供了76份呼吸道样本（72份痰和4份BAL）。中位年龄为17岁（范围6个月至59岁）。在该队列中有49％观察到FC阳性。与稳定状态相比，肺部加重期间FC阳性更大（67％对50％）。在FC阳性组中，年龄5至30岁的参与者FEV1较低。在非参数测试（p = 0.022）和回归分析（p = 0.007）上观察到FC阳性与非结核分枝杆菌（NTM）培养之间存在显着关联。暴露于室内霉菌是FC阳性的预测指标（p = 0.047）。在FC阳性组中，存在肺清除指数（LCI），支气管扩张和静脉使用抗生素的趋势。FC阳性和阴性患者之间的生物标志物无显着差异。

曲霉。烟熏是从CF气管中培养出来的最常见的丝状真菌。我们发现FC阳性和阴性患者之间的气道生物标志物谱无差异。半乳甘露聚糖和TNFR2作为CF中真菌特异性生物标志物的作用仍不确定。在年轻患者中，FC阳性与FEV ₁降低，LCI，NTM阳性，支气管扩张和静脉内抗生素暴露相关。需要更大的试验来确定半乳甘露聚糖和TNF-R2作为CF中潜在的真菌生物标记物的作用。