Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki University Hospital, Nagasaki, Japan.
Med Mycol. 2011 Aug;49(6):581-7. doi: 10.3109/13693786.2010.548084. Epub 2011 Jan 5.
Although the diagnostic significance of isolating Aspergillus spp. from respiratory cultures has been studied in immunocompromised hosts with invasive pulmonary aspergillosis (IPA), little is known of such infections in immunocompetent patients with other forms of aspergillosis. In this study of adult pneumology ward patients, we examined the association between Aspergillus spp. and disease prevalence. Laboratory records from April 1998 to March 2009 were reviewed to identify patients with Aspergillus spp. in respiratory samples. Correlations between the isolated species and clinical characteristics of patients were evaluated. During the study period, 165 Aspergillus spp. isolates were detected in the respiratory cultures of 139 patients. Of these patients, 62 (45%) were colonized with Aspergillus spp. and displayed no clinical symptoms of aspergillosis, while 77 (55%) had a form of pulmonary aspergillosis, characterized as either chronic necrotizing pulmonary aspergillosis (CNPA) (48%), aspergilloma (29%), IPA (13%), or allergic bronchopulmonary aspergillosis (ABPA) (10%). The dominant species were Aspergillus fumigatus (41%), A. niger (32%), and A. versicolor (12%). A. fumigatus was most commonly isolated in patients with IPA, aspergilloma, and CNPA, whereas A. niger was the dominant species in colonized patients and those with ABPA. Isolation of an Aspergillus spp. from respiratory samples does not confirm it as the etiologic pathogen because airway colonization by Aspergillus spp. is a common feature in several chronic lung diseases. Repeated isolation of the identical Aspergillus species and detection of anti-Aspergillus antibodies and/or Aspergillus antigens in sera are needed to determine the isolate represents the etiologic agent of disease.
虽然从免疫功能低下的宿主的侵袭性肺曲霉病（IPA）的呼吸道培养物中分离出曲霉菌属已被研究用于诊断，但对于免疫功能正常的患有其他形式曲霉病的患者的此类感染却知之甚少。在这项针对成人呼吸病房患者的研究中，我们研究了曲霉菌属与疾病流行之间的关联。对 1998 年 4 月至 2009 年 3 月的实验室记录进行了回顾，以鉴定呼吸道样本中存在的曲霉菌属。评估了分离物种与患者临床特征之间的相关性。在研究期间，在 139 名患者的呼吸道培养物中检测到 165 株曲霉菌属。这些患者中，有 62 名（45％）定植有曲霉菌属，没有曲霉病的临床症状，而 77 名（55％）患有某种形式的肺曲霉病，特征为慢性坏死性肺曲霉病（CNPA）（48％），曲霉肿（29％），IPA（13％）或变应性支气管肺曲霉病（ABPA）（10％）。优势种为烟曲霉（41％），黑曲霉（32％）和杂色曲霉（12％）。烟曲霉最常从 IPA、曲霉肿和 CNPA 患者的呼吸道标本中分离出来，而黑曲霉是定植患者和 ABPA 患者的优势种。从呼吸道样本中分离出曲霉菌属并不能确认其为病原体，因为曲霉菌属在几种慢性肺部疾病中均存在气道定植现象。需要反复分离相同的曲霉种，并在血清中检测抗曲霉抗体和/或曲霉抗原，以确定分离株是否代表疾病的病原体。
