Medical news
of the North Caucasus
Scientific journal
Mass media registration certificate dated December 7, 2006.
Series ПИ #ФС 77-26521.
Federal service for surveillance over non-violation of the legislation in the sphere of mass communications and protection of cultural heritage.
ISSN 2073-8137

Site search

Correspondence address
310 Mira Street, Stavropol, Russia, 355017

+7 8652 352524; +7 8652 353229.

+7 8652 352524.


Experience of allergic bronchopulmonal aspergillosis therapy in children with cystic fibrosis

[Cystic fibrosis]
Roman Mikhailovich Budzinsky; Elena Ivanovna Kondratieva; Nuriniso Dzhumaevna Odinaeva; Victoria Davidovna Sherman; Elena Kestutisovna Zhekaite;

Violation of mucociliary clearance and immune response, as well as prolonged antibacterial and glucocorticoid therapy, contribute to the development of allergic bronchopulmonary aspergillosis (ABPA) and pulmonary mycosis in CF patients. ABPA treatment regimens are discussed, and there is no information on relapse therapy. The aim of this work was to summarize the existing experience in the treatment of ABPA in children with cystic fibrosis in the children’s center for cystic fibrosis. А retrospective analysis of case histories of children observed in the center of CF for the period from 2016 to 2019 was carried out. The clinical manifestations of ABPA among the analyzed patients were in the form of increased cough, increased sputum discharge, manifestations of bronchial obstructive syndrome. Culturing of gram-negative non-enzymatic microflora was characteristic of all children diagnosed with ABPA, however, courses of systemic antibiotic therapy did not lead to significant dynamics in the condition of patients. An increase in total IgE was observed in 100% of patients with cystic fibrosis in ABPA and should be used as a screening among patients with CF. The use of combined antimycotic and glucocorticosteroid therapy leads to a cure for ABPA, but does not exclude a relapse. The course can range from 1 to 6 months. A burdened atopic history is a predisposing factor for the formation of a relapsing form of ABPA.


1. Kapranov N. I., Kashirskaya N. Yu. Cystic fibrosis. M.: Medpractica-М, 2014. (In Russ).
2. Kondratyeva E. I., Kashirskaya N. Yu., Kapranov N. I. National Consensus «Cystic fibrosis: definition, diagnostic criteria, therapy», Natsionalny konsensus «Mukovistsidoz: opredeleniye, diagnosticheskiye kriterii, terapiya». M.: Borges company, 2016. (In Russ).
3. Chmiel J. F., Aksamit T. R., Chotirmall S. H. [et al.]. Antibiotic management of lung infections in cystic fibrosis. I. The microbiome, methicillin-resistant Staphylococcus aureus, gram-negative bacteria, and multiple infections. Ann. Am. Thorac. Soc. 2014;11:1120-1129.
4. Cystic fibrosis: microbiological diagnosis of chronic respiratory infection, Kistozny fibroz (mukovistsidoz): mikrobiologicheskaya diagnostika khronicheskoy respiratornoy infektsii, 2018. Available at: http://www.fedlab.ru/upload/dokumenty/kp-mukovistidos2018.pdf. Accessed September 22, 2019 (In Russ.).
5. Tunnicliffe G., Schomberg L., Walsh S. [et al.]. Airway and parenchymal manifestations of pulmonary aspergillosis. Respir. Med. 2013;107:1113-1123.
6. Pihet M., Carrere J., Cimon B. [et al.]. Occurrence and relevance of filamentous fungi in respiratory secretions of patients with cystic fibrosis – a review. Medical Mycology. 2009;47:387-397.
7. Lipuma J. J. The Changing Microbial Epidemiology in Cystic Fibrosis. Clin. Microbiol. Rev. 2010;23(2):299-323.
8. Geller D. E., Kaplowitz H., Light M. J. [et al.]. Allergic bronchopulmonary aspergillosis in cystic fibrosis: reported prevalence, regional distribution, and patient characteristics. Scientific Advisory Group, Investigators, and Coordinators of the Epidemiologic Study of Cystic Fibrosis. Chest. 1999;116:639-646.
9. Stevens D. A., Moss R. B., Kurup V. P. [et al.]. Allergic bronchopulmonary aspergillosis in cystic fibrosis – state of the art: Cystic Fibrosis Foundation Consensus Conference. Clin. Infect. Dis. 2003;37Suppl3:225-264.
10. Kozlova Ya. I., Borzova Yu. V., Suslova I. E., Bogomolova T. S., Aak O. V. [et al.]. Lung aspergillosis in patients with cystic fibrosis. Aspergillez legkikh u bolnykh mukovistsidozom. Zhurnal infektologii. – Infectology Journal. 2018;10(2):48-54. (In Russ.). https://doi.org/10.22625/2072-6732-2018-10-2-48-54
11. Klimko N. N. Mycoses: diagnosis and treatment. Mikozy: diagnostika i lecheniye Rukovodstvo dlya vrachey. M.: Farmtek, 2017. (In Russ.).
12. Mastella G., Rainisio M., Harms H. K. [et al.]. Allergic bronchopulmonary aspergillosis in cystic fibrosis: a European epidemiological study. Epidemiologic Registry of Cystic Fibrosis. Eur. Respir. J. 2000;16(3):464-471. https://doi.org/10.1034/j.1399-3003.2000.016003464.x
13. Miller M. R., Hankinson J., Brusasco V. [et al.]. Standardisation of spirometry. Series «ATS/ERS task force: standardisation of lung function testing». Eur. Respir. J. 2005;26:319-338.
14. Pellegrino R., Viegi G., Brusasco V. [et al.]. Interpretative strategies for lung function tests. Series «ATS/ERS task force: standardisation of lung function testing». Eur. Respir. J. 2005;26:511-522.
15. Cooper P. J., Robertson C. F., Hudson I. L, Phelan P. D. Variability of pulmonary function tests in cystic fibrosis. Pediatr. Pulmonol. 1990;8(1):16-22. https://doi.org/10.1002/ppul.1950080107
16. Burgel P. R., Paugam A., Hubert D., Clémence M. Aspergillus fumigatus in the cystic fibrosis lung: pros and cons of azole therapy. Infect. Drug. Resist. 2016;9:229-238.
17. Hamprecht A., Morio F., Bader O. [et al.]. Azole Resistance in Aspergillus fumigatus in Patients with Cystic Fibrosis: A Matter of Concern? Mycopathologia. 2018;183:151.
18. Troke P. F., Hockey H. P., Hope W. W. Observational study of the clinical efficacy of voriconazole and its relationship to plasma concentrationsin patients. Antimicrob. Agents Chemother. 2011;55:4782-4788.
19. Arendrup M. C., Bruun B., Christensen J. J. [et al.]. National surveillance of fungemia in Denmark (2004 to 2009). J. Clin. Microbiol. 2011;49:325-334.
20. Lockhart S. R., Wagner D., Iqbal N. [et al.]. Comparison of in vitro susceptibility characteristics of Candida species from cases of invasive candidiasis in solid organ and stem cell transplant recipients: Transplant-Associated Infections Surveillance Network (TRANSNET), 2001 to 2006. J. Clin. Microbiol. 2011;49:2404-2410.
21. Pfaller M., Boyken L., Hollis R. [et al.]. Use of epidemiological cutoff values to examine 9-year trends in susceptibility of Aspergillus species to the triazoles. J. Clin. Microbiol. 2011;49:586-590.

Keywords: cystic fibrosis, CF, ABPA, voriconazole, itraconazole, aspergillosis, relapse

Stavropol State Medical Academy
Pyatigorsk State Research Institute of Balneotherapeutics
Pyatigorsk State Pharmaceutical Academy