Soubani AO , Chandrasekar PH , 2002. The clinical spectrum of pulmonary aspergillosis. Chest 121: 1988–1999.
Barac A , Kosmidis C , Alastruey-Izquierdo A , Salzer HJF , 2019. CPAnet. Chronic pulmonary aspergillosis update: a year in review. Med Mycol 57 (Suppl 2):S104–S109.
Brown GD , Denning DW , Gow NAR , Levitz SM , Netea MG , White TC , 2012. Hidden killers: human fungal infections. Sci Transl Med 4: 165rv13.
Denning DW et al., 2016. Chronic pulmonary aspergillosis: rationale and clinical guidelines for diagnosis and management. Eur Respir J 47: 45–68.
Izumikawa K et al., 2012. Bronchoalveolar lavage galactomannan for the diagnosis of chronic pulmonary aspergillosis. Med Mycol 50: 811–817.
Anan K , Kataoka Y , Okabayashi S , Yamamoto R , Namkoong H , Yamamoto Y , 2021. Diagnostic accuracy of Aspergillus-specific antibodies for chronic pulmonary aspergillosis: a systematic review and meta-analysis. Mycoses 64: 701–715.
Ullmann AJ et al., 2018. Diagnosis and management of Aspergillus diseases: executive summary of the 2017 ESCMID-ECMM-ERS guideline. Clin Microbiol Infect 24 (Suppl 1):e1–e38.
Zhong H et al., 2022. Clinical features, diagnostic test performance, and prognosis in different subtypes of chronic pulmonary aspergillosis. Front Med (Lausanne) 9: 811807.
Hou X , Zhang H , Kou L , Lv W , Lu J , Li J , 2017. Clinical features and diagnosis of chronic pulmonary aspergillosis in Chinese patients. Medicine (Baltimore) 96: e8315.
Sehgal IS et al., 2019. Utility of serum and bronchoalveolar lavage fluid galactomannan in diagnosis of chronic pulmonary aspergillosis. J Clin Microbiol 57: e01821-18.
Shin B et al., 2014. Serum galactomannan antigen test for the diagnosis of chronic pulmonary aspergillosis. J Infect 68: 494–499.
Kono Y et al., 2013. The utility of galactomannan antigen in the bronchial washing and serum for diagnosing pulmonary aspergillosis. Respir Med 107: 1094–1100.
Binder RE , Faling LJ , Pugatch RD , Mahasaen C , Snider GL , 1982. Chronic necrotizing pulmonary aspergillosis: a discrete clinical entity. Medicine (Baltimore) 61: 109–124.
Bernstein RM , Bunn CC , Hughes GR , 1982. Identification of antibodies to acidic antigens by counterimmunoelectrophoresis. Ann Rheum Dis 41: 554–555.
Wilopo BAP , Richardson MD , Denning DW , Diagnostic aspects of chronic pulmonary aspergillosis: present and new directions. Curr Fungal Infect Rep 13: 292–300.
Volpe Chaves CE et al., 2020. Accuracy of serological tests for diagnosis of chronic pulmonary aspergillosis: a systematic review and meta-analysis. PLoS One 15: e0222738.
Iqbal N , Irfan M , Zubairi ABS , Jabeen K , Awan S , Khan JA , 2016. Clinical manifestations and outcomes of pulmonary aspergillosis: experience from Pakistan. BMJ Open Respir Res 3: e000155.
Chawla K , Kosaraju K , Rayasam S , Mukhopadhyay C , 2013. Clinico-microbiological profile of chronic pulmonary aspergillosis from a tertiary care centre in southern India. J Clin Diagn Res 7: 2712–2715.
Denning DW , Riniotis K , Dobrashian R , Sambatakou H , 2003. Chronic cavitary and fibrosing pulmonary and pleural aspergillosis: case series, proposed nomenclature change, and review. Clin Infect Dis 37 (Suppl 3):S265–S280.
Camuset J et al., 2007. Treatment of chronic pulmonary aspergillosis by voriconazole in nonimmunocompromised patients. Chest 131: 1435–1441.
Ved P , Mishra PP , Verma SK , Sinha S , Sharma M , 2014. Prevalence and fungal profile of pulmonary aspergillosis in immunocompromised and immunocompetent patients of a tertiary care hospital. Inte Jour of Medi Res & Health Sci 3: 92.
Jhun BW et al., 2013. Clinical characteristics and treatment outcomes of chronic pulmonary aspergillosis. Med Mycol 51: 811–817.
|Past two years||Past Year||Past 30 Days|
|Full Text Views||34||34||8|
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.
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: firstname.lastname@example.org, email@example.com, firstname.lastname@example.org, and email@example.com. Joshua Araújo Viana and Marcio Valente Yamada Sawamura, Department of Radiology of Hospital das Clínicas, University of São Paulo, São Paulo, Brazil, E-mails: firstname.lastname@example.org and email@example.com. Andre Nathan Costa, Department of Pneumology of Hospital das Clínicas, University of São Paulo, São Paulo, Brazil, E-mail: firstname.lastname@example.org. Alessandro Wasum Mariani, Department of Thoracic Surgery of Hospital das Clínicas, University of São Paulo, São Paulo, Brazil, E-mail: email@example.com. 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: firstname.lastname@example.org.