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      Chronic Pulmonary Aspergillosis in Patients with Underlying Respiratory Disorders in Cuba—A Pilot Study

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          Abstract

          Chronic pulmonary aspergillosis (CPA) is a fungal infection with high mortality and morbidity rates. This disease is caused by several Aspergillus species and affects patients with an underlying respiratory condition. This pilot study aims to recognize CPA among patients with different respiratory diseases. Twenty-one out of 47 patients were classified as CPA based on the examination of clinical signs and symptoms, radiological findings, mycological culture of respiratory samples and analysis of Aspergillus IgG antibodies. There was a close association between high levels of Aspergillus IgG antibodies and the presence of cavities. Although Aspergillus flavus was the predominant species among clinical isolates, the number of isolates was small to reach conclusions on the prevalence of this species as main cause of CPA in Cuba. From the eleven evaluable patients for the treatment with itraconazole (Lozartil ®), nine improved their health status while two did not show any recovery. This drug is included in the therapy schemes for aspergillosis in Cuba.

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          Most cited references27

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          Practice Guidelines for the Diagnosis and Management of Aspergillosis: 2016 Update by the Infectious Diseases Society of America.

          It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. IDSA considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient's individual circumstances.
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            The mycobiota: interactions between commensal fungi and the host immune system.

            The body is host to a wide variety of microbial communities from which the immune system protects us and that are important for the normal development of the immune system and for the maintenance of healthy tissues and physiological processes. Investigators have mostly focused on the bacterial members of these communities, but fungi are increasingly being recognized to have a role in defining these communities and to interact with immune cells. In this Review, we discuss what is currently known about the makeup of fungal communities in the body and the features of the immune system that are particularly important for interacting with fungi at these sites.
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              Aspergillus flavus: human pathogen, allergen and mycotoxin producer.

              Aspergillus infections have grown in importance in the last years. However, most of the studies have focused on Aspergillus fumigatus, the most prevalent species in the genus. In certain locales and hospitals, Aspergillus flavus is more common in air than A. fumigatus, for unclear reasons. After A. fumigatus, A. flavus is the second leading cause of invasive aspergillosis and it is the most common cause of superficial infection. Experimental invasive infections in mice show A. flavus to be 100-fold more virulent than A. fumigatus in terms of inoculum required. Particularly common clinical syndromes associated with A. flavus include chronic granulomatous sinusitis, keratitis, cutaneous aspergillosis, wound infections and osteomyelitis following trauma and inoculation. Outbreaks associated with A. flavus appear to be associated with single or closely related strains, in contrast to those associated with A. fumigatus. In addition, A. flavus produces aflatoxins, the most toxic and potent hepatocarcinogenic natural compounds ever characterized. Accurate species identification within Aspergillus flavus complex remains difficult due to overlapping morphological and biochemical characteristics, and much taxonomic and population genetics work is necessary to better understand the species and related species. The flavus complex currently includes 23 species or varieties, including two sexual species, Petromyces alliaceus and P. albertensis. The genome of the highly related Aspergillus oryzae is completed and available; that of A. flavus in the final stages of annotation. Our understanding of A. flavus lags far behind that of A. fumigatus. Studies of the genomics, taxonomy, population genetics, pathogenicity, allergenicity and antifungal susceptibility of A. flavus are all required.
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                Author and article information

                Journal
                J Fungi (Basel)
                J Fungi (Basel)
                jof
                Journal of Fungi
                MDPI
                2309-608X
                22 February 2019
                March 2019
                : 5
                : 1
                : 18
                Affiliations
                [1 ]Benéfico-Jurídico Pneumological Hospital, 10600 Havana, Cuba; nathaliebeltran@ 123456infomed.sld.cu (N.B.R.); bibliobecjuridico@ 123456infomed.sld.cu (D.M.Y.); mirita@ 123456infomed.sld.cu (M.B.P.)
                [2 ]Pedro Kourí Institute of Tropical Medicine, 17100 Havana, Cuba; jlsanjuan9@ 123456ipk.sld.cu (J.L.S.J.-G.); cfandreu@ 123456ipk.sld.cu (C.M.F.A.); mrpl@ 123456ipk.sld.cu (M.R.P.L.); velar@ 123456ipk.sld.cu (R.E.V.M.); mtilnait@ 123456ipk.sld.cu (M.T.I.Z.)
                Author notes
                [* ]Correspondence: gerardo@ 123456ipk.sld.cu ; Tel.: +537-255-35-21
                Author information
                https://orcid.org/0000-0001-5943-715X
                Article
                jof-05-00018
                10.3390/jof5010018
                6463116
                30813272
                a34795a7-9dca-4500-8f1d-428afc269566
                © 2019 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 13 December 2018
                : 15 February 2019
                Categories
                Article

                aspergillosis,diagnosis,cavities,igg,itraconazole
                aspergillosis, diagnosis, cavities, igg, itraconazole

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