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Archives de pédiatrie
Volume 18, n° S1
pages 15-21 (mai 2011)
Doi : 10.1016/S0929-693X(11)70936-8
Infections fongiques au cours de la mucoviscidose
Fungal infections in cystic fibrosis
 

M. Le Bourgeois , I. Sermet, C. Bailly-Botuha, C. Delacourt, J. de Blic
Service de Pneumologie et Allergologie Pédiatriques, Hôpital Necker-Enfants-Malades, 149, rue de Sèvres, 75015 Paris, France 

Auteur correspondant.
Résumé

Au cours de la mucoviscidose, la colonisation fongique est fréquente et dominée par Aspergillus fumigatus (A. fumigatus ). Des analyses mycologiques sur milieux sélectifs ont mis en évidence d’autres espèces filamenteuses Scedosporium, Geosmithia argillacea . Des études prospectives sont nécessaires pour apprécier leur prévalence et leur caractère pathogène.

A. fumigatus est le plus souvent responsable d’une aspergillose broncho-pulmonaire allergique (ABPA). L’infection invasive est exceptionnelle dans ce contexte. Un diagnostic précoce d’ABPA est important pour éviter la détérioration bronchique cependant, il est difficile malgré des recommandations internationales. De nouveaux marqueurs biologiques plus spécifiques sont en cours d’évaluation. Le traitement repose sur la corticothérapie orale dont les effets indésirables sont plus fréquents au cours de la mucoviscidose. L’association à des antifongiques permet une épargne corticoïde. De nouvelles stratégies thérapeutiques sont en cours d’étude en cas de cortico-dépendance ou en cas de résistance fongique.

The full text of this article is available in PDF format.
Summary

Fungal colonization in cystic fibrosis patient is frequent and dominated by Aspergillus fumigatus (A. fumigatus ). Mycological analysis on specific media showed other filamentous species Scedosporium, Geosmithia argillacea . Prospective studies are necessary to appreciate prevalence and pathogenicity in this pathology. A. fumigatus causes the most frequently allergic bronchopulmonary aspergillosis (ABPA). Invasive infection is exceptional in this context. An early diagnosis is important to avoid bronchial deterioration but is very difficult despite international consensus. New more specific biological markers are evaluated.

Oral corticotherapy is the cornerstone of therapy but adverse effects are more frequent in cystic fibrosis. Antifungal therapy has a corticosteroid-sparing effect. New therapeutic strategies have to be evaluated.

The full text of this article is available in PDF format.


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