Candida Albicans Colonization is Associated with a More Severe Lung Disease in Patients with Cystic Fibrosis

Background: Cystic fibrosis (CF) is characterized by chronic infection and inflammation of the airways resulting in progressive lung damage leading to respiratory failure and early death. Over the last decade, a significant increase in the prevalence of fungi in CF respiratory cultures was reported. Candida species, especially C. albicans, are often recovered from CF sputum cultures. Other Candida species including C. glabrata, C. parapsilosis and C. dubliniensis are much less frequently found and their pathogenicity is unclear. The common use of antibiotics as well as oral and inhaled steroids may predispose CF patients to colonization by Candida species. Aim: To investigate the prevalence and persistence rate of Candida albicans and other Candida species colonization in the respiratory tract of patients with CF, and to assess the correlation between these infections and the severity of lung disease. Results: 4,245 sputum cultures taken from 91 CF patients during 2003-2009 were retrospectively analyzed. No differences in terms of age, sex, BMI values and concomitant colonization by MSSA or Pseudomonas aeruginosa were found, between patients chronically colonized and non-colonized by Candida in sputum. Candida albicans colonization was statistically significant more frequently found in patients with CF and pancreatic insufficiency, CF-related diabetes, lower values of FEV1, as well as in patients chronically colonized by Aspergillus fumigatus. Conclusions: Candida albicans colonization is associated with a more severe lung disease in patients with CF. Prospective studies are required in order to assess the necessity of antifungal treatment in patients with CF colonized by Candida in the airways.