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Sensitivity of Antigen, Serology, and Microbiology Assays for Diagnosis of the Subtypes of Chronic Pulmonary Aspergillosis at a Teaching Hospital in São Paulo, Brazil

Vítor Falcão de OliveiraDepartment of Infectious and Parasitic Diseases of Hospital das Clínicas, University of São Paulo, São Paulo, Brazil;

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Joshua Araújo Viana Department of Radiology of Hospital das Clínicas, University of São Paulo, São Paulo, Brazil;

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Marcio Valente Yamada Sawamura Department of Radiology of Hospital das Clínicas, University of São Paulo, São Paulo, Brazil;

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Adriana Satie Gonçalves Kono MagriDepartment of Infectious and Parasitic Diseases of Hospital das Clínicas, University of São Paulo, São Paulo, Brazil;

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Andre Nathan Costa Department of Pneumology of Hospital das Clínicas, University of São Paulo, São Paulo, Brazil;

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Edson AbdalaDepartment of Infectious and Parasitic Diseases of Hospital das Clínicas, University of São Paulo, São Paulo, Brazil;

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Alessandro Wasum Mariani Department of Thoracic Surgery of Hospital das Clínicas, University of São Paulo, São Paulo, Brazil;

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Gil Benard Laboratory of Medical Mycology (LIM-53), Instituto de Medicina Tropical e Division of Clinical Dermatology, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil

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Marcello Mihailenko Chaves MagriDepartment of Infectious and Parasitic Diseases of Hospital das Clínicas, University of São Paulo, São Paulo, Brazil;

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ABSTRACT.

Chronic pulmonary aspergillosis (CPA) is divided into five subtypes. The diagnosis of CPA is complicated due to poor sensitivity of the laboratory tests. Diagnostic performance of different antigen, serological, and microbiological methods in subtypes of CPA is unknown. The purpose of this study was to evaluate the diagnostic performance in different subtypes of CPA. A total of 91 participants with CPA were included, and the study was performed at Hospital das Clínicas of University of São Paulo. Bronchoalveolar lavage galactomannan (73%, 11/15), serology by immunodiffusion test (81%, 61/75), and histology (78%, 39/50) had the best sensitivity. The counterimmunoelectrophoresis (CIE) titers had a significant statistical difference between the CPA subtypes (P < 0.001), in which the forms chronic fibrosing pulmonary aspergillosis (CFPA) and subacute invasive aspergillosis (SAIA) had higher titers: 1/64 (interquartile range [IQR]: 1/32–1/256) and 1/64 (1/32–1/128). C-reactive protein generally presented lower values (median 15 mg/L, IQR: 6–33), with higher values in SAIA and lower values for Aspergillus nodule. Overall, we found a low diagnostic sensitivity of current tests. Regarding the CPA subtypes, we did not find great differences in the performance of the tests, but it is observed that the inflammatory markers and CIE titers tend to be higher in forms of the more extensive lung parenchyma involvement, such as SAIA and CFPA.

Author Notes

Address correspondence to Vítor Falcão de Oliveira, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, 255 Av. Dr. Enéas Carvalho de Aguiar, Cerqueira César, São Paulo 05403-000, Brazil. E-mail: vitorfalcaodeoliveira@gmail.com

Authors’ addresses: Vítor Falcão de Oliveira, Adriana Satie Gonçalves Kono Magri, Edson Abdala, and Marcello Mihailenko Chaves Magri, Department of Infectious and Parasitic Diseases of Hospital das Clínicas, University of São Paulo, São Paulo, Brazil, E-mails: vitorfalcaodeoliveira@gmail.com, adriana_kono@yahoo.com.br, eabdala@uol.com.br, and marcello.magri@hc.fm.usp.br. Joshua Araújo Viana and Marcio Valente Yamada Sawamura, Department of Radiology of Hospital das Clínicas, University of São Paulo, São Paulo, Brazil, E-mails: joshua.viana@hc.fm.usp.br and marcio.sawamura@hc.fm.usp.br. Andre Nathan Costa, Department of Pneumology of Hospital das Clínicas, University of São Paulo, São Paulo, Brazil, E-mail: nathan.andre@gmail.com. Alessandro Wasum Mariani, Department of Thoracic Surgery of Hospital das Clínicas, University of São Paulo, São Paulo, Brazil, E-mail: alessandro.mariani@hc.fm.usp.br. Gil Benard, Laboratory of Medical Mycology (LIM-53), Instituto de Medicina Tropical e Division of Clinical Dermatology, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil, E-mail: bengil60@gmail.com.

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