{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T15:49:16Z","timestamp":1753890556910,"version":"3.41.2"},"reference-count":68,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,1,22]],"date-time":"2021-01-22T00:00:00Z","timestamp":1611273600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cell. Infect. Microbiol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To investigate the clinical characteristics and airway biomarker profile in relation to the detection of filamentous fungi in respiratory samples obtained from CF patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Sixty-one patients provided 76 respiratory samples (72 sputum and 4 BAL). Median age was 17 years (range 6 months\u201359 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\u201330 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p><jats:italic>Aspergillus. fumigatus<\/jats:italic> 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 FEV<jats:sub>1<\/jats:sub> 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.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fcimb.2020.605241","type":"journal-article","created":{"date-parts":[[2021,1,22]],"date-time":"2021-01-22T05:31:46Z","timestamp":1611293506000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":5,"title":["Comparative Analysis of Clinical Parameters and Sputum Biomarkers in Establishing the Relevance of Filamentous Fungi in Cystic Fibrosis"],"prefix":"10.3389","volume":"10","author":[{"given":"Deepa","family":"Patel","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Keith Chester","family":"Dacanay","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Catherine H.","family":"Pashley","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erol A.","family":"Gaillard","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2021,1,22]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"988","DOI":"10.3109\/13693781003743148","article-title":"Aspergillus hypersensitivity in patients with chronic obstructive pulmonary disease: COPD as a risk factor for ABPA","volume":"48","author":"Agarwal","year":"2010","journal-title":"Med. Mycology"},{"key":"B2","doi-asserted-by":"publisher","first-page":"782","DOI":"10.1111\/j.1365-2222.2012.03987","article-title":"Isolation of filamentous fungi from sputum in asthma is associated with reduced post-bronchodilator FEV1","volume":"42","author":"Agbetile","year":"2012","journal-title":"Clin. Exp. Allergy"},{"key":"B3","doi-asserted-by":"publisher","first-page":"257","DOI":"10.1002\/ppul.24220","article-title":"Early detection of non-tuberculous mycobacteria in children with cystic fibrosis using induced sputum at annual review","volume":"54","author":"Ahmed","year":"2019","journal-title":"Pediatr. Pulmonol."},{"key":"B4","doi-asserted-by":"publisher","first-page":"171","DOI":"10.1378\/chest.09-1103","article-title":"The effect of chronic infection with Aspergillus fumigatus on lung function and hospitalization in patients with cystic fibrosis","volume":"137","author":"Amin","year":"2010","journal-title":"Chest"},{"key":"B5","doi-asserted-by":"publisher","first-page":"500","DOI":"10.1002\/ppul.20294","article-title":"Lower Airway Inflammation in Infants with Cystic Fibrosis Detected by Newborn Screening","volume":"40","author":"Armstrong","year":"2005","journal-title":"Pediatr. Pulmonol."},{"key":"B6","doi-asserted-by":"publisher","first-page":"287","DOI":"10.1016\/j.diagmicrobio.2008.06.018","article-title":"Serologic diagnosis of allergic bronchopulmonary aspergillosis in patients with cystic fibrosis through the detection of immunoglobulin G to Aspergillus fumigatus","volume":"62","author":"Barton","year":"2008","journal-title":"Diagn. Microbiol. Infect. Dis."},{"key":"B7","doi-asserted-by":"publisher","first-page":"560","DOI":"10.1016\/j.jaci.2013.04.007","article-title":"Novel immunologic classification of aspergillosis in adult cystic fibrosis","volume":"132","author":"Baxter","year":"2013","journal-title":"J. Allergy Clin. Immunol."},{"key":"B8","doi-asserted-by":"publisher","first-page":"1351","DOI":"10.1378\/chest.12-1363","article-title":"IgE-Mediated Immune Responses and Airway Detection of Aspergillus and Candida in Adult Cystic Fibrosis","volume":"143","author":"Baxter","year":"2013","journal-title":"Chest"},{"volume-title":"SOP: Sputum processing procedure","year":"2016","author":"Bhatt","key":"B9"},{"key":"B10","doi-asserted-by":"publisher","first-page":"S88","DOI":"10.3109\/13693786.2010.511287","article-title":"Lack of standardization in the procedures for mycological examination of sputum samples from CF patients: a possible cause for variations in the prevalence of filamentous fungi","volume":"48","author":"Borman","year":"2010","journal-title":"Med. Mycology"},{"key":"B11","doi-asserted-by":"publisher","first-page":"1480","DOI":"10.1016\/S0140-6736(00)02872-5","article-title":"Sputum eosinophilia and short-term response to prednisolone in chronic obstructive pulmonary disease: a randomised controlled trial","volume":"356","author":"Brightling","year":"2000","journal-title":"Lancet (British edition)"},{"key":"B12","doi-asserted-by":"publisher","first-page":"158","DOI":"10.1086\/514631","article-title":"Microbiology of Sputum from Patients at Cystic Fibrosis Centers in the United States","volume":"27","author":"Burns","year":"1998","journal-title":"Clin. Infect. Dis."},{"key":"B13","doi-asserted-by":"publisher","first-page":"1384","DOI":"10.1164\/rccm.201605-1027OC","article-title":"Neutrophil Elastase Activity Is Associated with Exacerbations and Lung Function Decline in Bronchiectasis","volume":"195","author":"Chalmers","year":"2017","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"B14","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1007\/s11046-017-0150-8","article-title":"Challenges in Laboratory Detection of Fungal Pathogens in the Airways of Cystic Fibrosis Patients","volume":"183","author":"Chen","year":"2017","journal-title":"Mycopathologia (1975)"},{"key":"B15","doi-asserted-by":"publisher","first-page":"161","DOI":"10.1016\/j.biocel.2014.03.001","article-title":"Fungi in the cystic fibrosis lung: Bystanders or pathogens","author":"Chotirmall","year":"2014","journal-title":"Int. J. Biochem. Cell Biol."},{"key":"B16","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1002\/ppul.20237","article-title":"Cytokine levels in sputum of cystic fibrosis patients before and after antibiotic therapy","volume":"40","author":"Colombo","year":"2005","journal-title":"Pediatr. Pulmonol."},{"key":"B17","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1186\/gm467","article-title":"The human mycobiome in health and disease","volume":"5","author":"Cui","year":"2013","journal-title":"Genome Med."},{"key":"B18","doi-asserted-by":"publisher","first-page":"96","DOI":"10.1136\/thx.2007.077784","article-title":"Lung clearance index in CF: a sensitive marker of lung disease severity","volume":"63","author":"Davies","year":"2008","journal-title":"Thorax"},{"key":"B19","doi-asserted-by":"publisher","first-page":"217","DOI":"10.1183\/09031936.00.15121700","article-title":"Ers Task Force on bronchoalveolar lavage in children and Members of the Task Force: \u2018Bronchoalveolar lavage in children\u2019","volume":"15","author":"De Blic","year":"2000","journal-title":"Eur. Respir. J."},{"key":"B20","doi-asserted-by":"publisher","first-page":"1381","DOI":"10.1111\/j.1469-0691.2010.03429.x","article-title":"\u2018Aspergillus fumigatus colonization in cystic fibrosis: implications for lung function?\u2019","volume":"17","author":"De Vrankrijker","year":"2011","journal-title":"Clin. Microbiol. Infect."},{"key":"B21","doi-asserted-by":"publisher","first-page":"1362","DOI":"10.1164\/rccm.201001-0087oc","article-title":"IgE sensitization to aspergillus fumigatus is associated with reduced lung function in asthma","volume":"182","author":"Fairs","year":"2010","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"B22","doi-asserted-by":"publisher","first-page":"275","DOI":"10.1111\/ina.12020","article-title":"Isolation of Aspergillus fumigatus from sputum is associated with elevated airborne levels in homes of patients with asthma","volume":"23","author":"Fairs","year":"2013","journal-title":"Indoor Air"},{"key":"B23","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1016\/j.mimet.2017.06.016","article-title":"Comparative performance of Aspergillus galactomannan ELISA and PCR in sputum from patients with ABPA and CPA","volume":"140","author":"Fayemiwo","year":"2017","journal-title":"J. Microbiol. Methods"},{"key":"B24","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1111\/myc.12103","article-title":"Volume dependency for culture of fungi from respiratory secretions and increased sensitivity of Aspergillus quantitative PCR","volume":"57","author":"Fraczek","year":"2014","journal-title":"Mycoses"},{"key":"B25","doi-asserted-by":"publisher","first-page":"1104","DOI":"10.1136\/thoraxjnl-2016-209279","article-title":"The lower airway microbiota in early cystic fibrosis lung disease: a longitudinal analysis","volume":"72","author":"Frayman","year":"2017","journal-title":"Thorax"},{"key":"B26","doi-asserted-by":"publisher","first-page":"A11","DOI":"10.1136\/thorax-2019-BTSabstracts2019.22","article-title":"S16\u2005The influence of the CFTR modulator ivacaftor on aspergillosis in cystic fibrosis","volume":"74","author":"Fritsch","year":"2019","journal-title":"Thorax"},{"key":"B27","doi-asserted-by":"publisher","first-page":"637","DOI":"10.1056\/NEJM199409083311003","article-title":"Effect of aerosolized recombinant human DNase on exacerbations of respiratory symptoms and on pulmonary function in patients with cystic fibrosis. The Pulmozyme Study Group","volume":"331","author":"Fuchs","year":"1994","journal-title":"New Engl. J. Med."},{"key":"B28","doi-asserted-by":"publisher","first-page":"177","DOI":"10.4168\/aair.2017.9.2.177","article-title":"\u2018Sputum Inflammatory Mediators Are Increased in Aspergillus fumigatus Culture-Positive Asthmatics\u2019","volume":"9","author":"Ghebre","year":"2017","journal-title":"Allergy Asthma Immunol. Res."},{"key":"B29","doi-asserted-by":"publisher","first-page":"144","DOI":"10.1186\/s12890-019-0906-7","article-title":"\u2018Severe exacerbations in moderate-to-severe asthmatics are associated with increased pro-inflammatory and type 1 mediators in sputum and serum\u2019","volume":"19","author":"Ghebre","year":"2019","journal-title":"BMC Pulmonary Med."},{"key":"B30","doi-asserted-by":"publisher","first-page":"1033","DOI":"10.1016\/S0190-9622(97)80307-6","article-title":"Identification of pathogenic fungi, Public Health Laboratory Service, London, (1996)","volume":"36","author":"Greer","year":"1997","journal-title":"J. Am. Acad. Dermatol."},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.3389\/fmicb.2018.00531","article-title":"Performance of molecular approaches for aspergillus detection and azole resistance surveillance in cystic fibrosis","volume":"9","author":"Guegan","year":"2018","journal-title":"Front. Microbiol."},{"key":"B32","doi-asserted-by":"publisher","first-page":"363","DOI":"10.1016\/j.jcf.2012.07.003","article-title":"Innate immunity in cystic fibrosis lung disease","volume":"11","author":"Hartl","year":"2012","journal-title":"J. Cystic Fibrosis"},{"key":"B33","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1128\/CMR.00036-10","article-title":"Clinical Significance of Microbial Infection and Adaptation in Cystic Fibrosis","author":"Hauser","year":"2011","journal-title":"Clin. Microbiol. Rev."},{"key":"B34","doi-asserted-by":"publisher","first-page":"658","DOI":"10.1183\/09031936.02.00248102","article-title":"A randomised clinical trial of nebulised tobramycin or colistin in cystic fibrosis","volume":"20","author":"Hodson","year":"2002","journal-title":"Eur. Respir. J."},{"key":"B35","doi-asserted-by":"publisher","first-page":"305","DOI":"10.1016\/S0163-4453(94)91943-7","article-title":"Inhibition of fungal growth by Pseudomonas aeruginosa and Pseudomonas cepacia isolated from patients with cystic fibrosis","volume":"28","author":"Kerr","year":"1994","journal-title":"J. Infect."},{"key":"B36","doi-asserted-by":"publisher","first-page":"183","DOI":"10.3390\/genes10030183","article-title":"Progression of Cystic Fibrosis Lung Disease from Childhood to Adulthood: Neutrophils, Neutrophil Extracellular Trap (NET) Formation, and NET Degradation","volume":"10","author":"Khan","year":"2019","journal-title":"Genes"},{"key":"B37","doi-asserted-by":"publisher","first-page":"463","DOI":"10.1007\/s12185-009-0429-8","article-title":"Detection of sputum Aspergillus galactomannan for diagnosis of invasive pulmonary aspergillosis in haematological patients","volume":"90","author":"Kimura","year":"2009","journal-title":"Int. J. Hematol."},{"key":"B38","doi-asserted-by":"publisher","first-page":"701","DOI":"10.1111\/j.1440-1843.2009.01548.x","article-title":"Comparison of Aspergillus galactomannan antigen testing with a new cut-off index and Aspergillus precipitating antibody testing for the diagnosis of chronic pulmonary aspergillosis","volume":"14","author":"Kitasato","year":"2009","journal-title":"Respirology (Carlton Vic.)"},{"key":"B39","doi-asserted-by":"publisher","first-page":"1211","DOI":"10.1164\/rccm.200603-423OC","article-title":"Effect of Allergic Bronchopulmonary Aspergillosis on Lung Function in Children with Cystic Fibrosis","volume":"174","author":"Kraemer","year":"2006","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"B40","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1186\/s12931-016-0489-2","article-title":"End-stage cystic fibrosis lung disease is characterised by a diverse inflammatory pattern: an immunohistochemical analysis","volume":"18","author":"Lammertyn","year":"2017","journal-title":"Respir. Res."},{"key":"B41","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1016\/j.jcf.2013.02.003","article-title":"What is the clinical significance of filamentous fungi positive sputum cultures in patients with cystic fibrosis","volume":"12","author":"Liu","year":"2013","journal-title":"J. cystic fibrosis Off. J. Eur. Cystic Fibrosis Soc."},{"key":"B42","doi-asserted-by":"publisher","first-page":"341","DOI":"10.1136\/thx.2006.068262","article-title":"Early detection of cystic fibrosis lung disease: multiple-breath washout versus raised volume tests","volume":"62","author":"Lum","year":"2007","journal-title":"Thorax"},{"key":"B43","doi-asserted-by":"publisher","first-page":"e197","DOI":"10.1016\/j.ejrad.2011.01.114","article-title":"Radiological abnormalities associated with Aspergillus colonization in a cystic fibrosis population","volume":"81","author":"McMahon","year":"2012","journal-title":"Eur. J. Radiol."},{"key":"B44","doi-asserted-by":"publisher","first-page":"349","DOI":"10.1016\/S1473-3099(04)01045-X","article-title":"Detection of circulating galactomannan for the diagnosis and management of invasive aspergillosis","volume":"4","author":"Mennink-Kersten","year":"2004","journal-title":"Lancet Infect. Dis."},{"key":"B45","doi-asserted-by":"publisher","first-page":"319","DOI":"10.1183\/09031936.05.00034805","article-title":"Standardisation of spirometry","volume":"26","author":"Miller","year":"2005","journal-title":"Eur. Respir. J."},{"key":"B46","doi-asserted-by":"publisher","first-page":"166","DOI":"10.3109\/13693780903127506","article-title":"Comparison of techniques to examine the diversity of fungi in adult patients with cystic fibrosis","volume":"48","author":"Nagano","year":"2010","journal-title":"Med. Mycol"},{"key":"B47","doi-asserted-by":"publisher","first-page":"2787","DOI":"10.1128\/JCM.00716-07","article-title":"Use of Bronchoalveolar Lavage To Detect Galactomannan for Diagnosis of Pulmonary Aspergillosis among Nonimmunocompromised Hosts","volume":"45","author":"Nguyen","year":"2007","journal-title":"J. Clin. Microbiol."},{"key":"B48","doi-asserted-by":"publisher","first-page":"2235","DOI":"10.1007\/s10096-015-2474-y","article-title":"Aspergillus fumigatus chronic colonization and lung function decline in cystic fibrosis may have a two-way relationship","volume":"34","author":"Noni","year":"2015","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"B49","doi-asserted-by":"publisher","first-page":"190046","DOI":"10.1183\/16000617.0046-2019","article-title":"Lung clearance index: assessment and utility in children with asthma","volume":"28","author":"Nuttall","year":"2019","journal-title":"Eur. Respir. Rev."},{"key":"B50","doi-asserted-by":"publisher","first-page":"3182","DOI":"10.1002\/eji.201344405","article-title":"The bacteriome-mycobiome interaction and antifungal host defense","volume":"44","author":"Oever","year":"2014","journal-title":"Eur. J. Immunol."},{"key":"B51","doi-asserted-by":"publisher","first-page":"1471","DOI":"10.1164\/rccm.200306-731OC","article-title":"Inflammatory and Microbiologic Markers in Induced Sputum after Intravenous Antibiotics in Cystic Fibrosis","volume":"168","author":"Ordonez","year":"2003","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"B52","doi-asserted-by":"publisher","first-page":"3s","DOI":"10.1183\/09031936.02.00000302","article-title":"Sputum induction","volume":"20","author":"Paggiaro","year":"2002","journal-title":"Eur. Respir. J."},{"volume-title":"SOP: Cytoslide Analysis Sputum Differential Cell","year":"2018","author":"Parker","key":"B53"},{"key":"B54","doi-asserted-by":"publisher","first-page":"433","DOI":"10.3109\/13693786.2011.615762","article-title":"Routine processing procedures for isolating filamentous fungi from respiratory sputum samples may underestimate fungal prevalence","volume":"50","author":"Pashley","year":"2012","journal-title":"Med. Mycology"},{"key":"B55","doi-asserted-by":"publisher","first-page":"e99","DOI":"10.1378\/chest.14-0635","article-title":"IgE Sensitization to Aspergillus fumigatus Is Not a Bystander Phenomenon in Cystic Fibrosis Lung Disease","volume":"146","author":"Peetermans","year":"2014","journal-title":"Chest"},{"key":"B56","doi-asserted-by":"publisher","first-page":"387","DOI":"10.1080\/13693780802609604","article-title":"Occurrence and relevance of filamentous fungi in respiratory secretions of patients with cystic fibrosis - a review","volume":"47","author":"Pihet","year":"2009","journal-title":"Med. Mycology"},{"volume-title":"Investigation of bronchoalveolar lavage, sputum and associated specimens","year":"2019","key":"B57"},{"key":"B58","doi-asserted-by":"publisher","first-page":"1111","DOI":"10.1164\/rccm.201407-1277OC","article-title":"Early Respiratory Infection Is Associated with Reduced Spirometry in Children with Cystic Fibrosis","volume":"190","author":"Ramsey","year":"2014","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"B59","doi-asserted-by":"publisher","first-page":"242","DOI":"10.1016\/j.jcf.2015.01.003","article-title":"Evaluation of mold exposure in cystic fibrosis patients\u2019 dwellings and allergic bronchopulmonary risk","volume":"14","author":"Rocchi","year":"2015","journal-title":"J. Cystic Fibrosis"},{"key":"B60","doi-asserted-by":"publisher","first-page":"183","DOI":"10.1016\/j.jpeds.2008.08.001","article-title":"Impact of Pseudomonas and Staphylococcus infection on inflammation and clinical status in young children with cystic fibrosis","volume":"154","author":"Sagel","year":"2009","journal-title":"J. Pediatr."},{"key":"B61","doi-asserted-by":"publisher","first-page":"537","DOI":"10.1093\/mmy\/myv119","article-title":"Chronic Aspergillus fumigatus colonization of the pediatric cystic fibrosis airway is common and may be associated with a more rapid decline in lung function","volume":"54","author":"Saunders","year":"2016","journal-title":"Med. Mycology"},{"key":"B62","doi-asserted-by":"publisher","first-page":"146","DOI":"10.1164\/rccm.200901-0069OC","article-title":"Lung Disease at Diagnosis in Infants with Cystic Fibrosis Detected by Newborn Screening","volume":"180","author":"Sly","year":"2009","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"B63","doi-asserted-by":"publisher","first-page":"L688","DOI":"10.1152\/ajplung.00146.2002","article-title":"Interleukin-8: a very important chemokine of the human airway epithelium","volume":"283","author":"Strieter","year":"2002","journal-title":"Am. J. Physiol. Lung Cell. Mol. Physiol."},{"key":"B64","doi-asserted-by":"publisher","first-page":"110","DOI":"10.1016\/j.jcf.2009.11.010","article-title":"Prevalence and risk factors for recovery of filamentous fungi in individuals with cystic fibrosis","volume":"9","author":"Sudfeld","year":"2009","journal-title":"J. Cystic Fibrosis"},{"key":"B65","doi-asserted-by":"publisher","first-page":"119","DOI":"10.1016\/j.jcrc.2017.03.025","article-title":"A prospective study of fungal biomarkers to improve management of invasive fungal diseases in a mixed specialty critical care unit","volume":"40","author":"Talento","year":"2017","journal-title":"J. Crit. Care"},{"key":"B66","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1016\/j.prrv.2009.01.001","article-title":"Diagnosing allergic bronchopulmonary aspergillosis in children with cystic fibrosis","volume":"10","author":"Thia","year":"2009","journal-title":"Paediatric Respir. Rev."},{"key":"B67","doi-asserted-by":"publisher","first-page":"S75","DOI":"10.1002\/ppul.24126","article-title":"The myriad challenges of respiratory fungal infection in cystic fibrosis","volume":"53","author":"Tracy","year":"2018","journal-title":"Pediatr. Pulmonol."},{"key":"B68","doi-asserted-by":"publisher","first-page":"729","DOI":"10.1002\/ppul.24278","article-title":"Change in lung clearance index with microbiological status in children with cystic fibrosis","volume":"54","author":"Walicka-Serzysko","year":"2019","journal-title":"Pediatr. Pulmonol."}],"container-title":["Frontiers in Cellular and Infection Microbiology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcimb.2020.605241\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,1,22]],"date-time":"2021-01-22T05:31:48Z","timestamp":1611293508000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcimb.2020.605241\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,1,22]]},"references-count":68,"alternative-id":["10.3389\/fcimb.2020.605241"],"URL":"https:\/\/doi.org\/10.3389\/fcimb.2020.605241","relation":{},"ISSN":["2235-2988"],"issn-type":[{"type":"electronic","value":"2235-2988"}],"subject":[],"published":{"date-parts":[[2021,1,22]]},"article-number":"605241"}}