Desoubeaux G, Bailly É, Chandenier J
Service de parasitologie-mycologie-médecine tropicale, pôle de biologie médicale, hôpital Bretonneau, CHU de Tours, bâtiment B2A, 1(er) étage, 2, boulevard Tonnellé, 37044 Tours cedex 9, France; CEPR-UMR Inserm U1100/EA 6305, faculté de médecine, université François-Rabelais, 37032 Tours cedex 1, France.
Service de parasitologie-mycologie-médecine tropicale, pôle de biologie médicale, hôpital Bretonneau, CHU de Tours, bâtiment B2A, 1(er) étage, 2, boulevard Tonnellé, 37044 Tours cedex 9, France.
Med Mal Infect. 2014 Mar;44(3):89-101. doi: 10.1016/j.medmal.2013.11.006. Epub 2014 Feb 16.
Invasive pulmonary aspergillosis is an opportunistic mycosis, difficult to diagnose, due to the environmental fungi of the genus Aspergillus. The diagnostic tools, even if more are available, are still limited in number and effectiveness. The current recommendations issued by the EORTC/MSG (European Organization of Research and Treatment of Cancer/Mycoses Study Group) and the ECIL (European Conference for Infection in Leukemia) suggest collecting epidemiological, radio-clinical, and biological data to support the diagnosis of aspergillosis with a strong presumption. Thus, medical imaging and serum galactomannan antigen currently constitute the basis of the screening approach, although they both have some limitations in specificity. (1→3)-β-D-glucans are pan-fungal serum markers with a very good negative predictive value. Real-time PCR lacks standardization, and fungal culture from respiratory specimens is sometimes not sensitive enough. Histology allows proving the diagnosis of aspergillosis, but biopsy is not always possible in immunodepressed patients. We present the various arguments for the diagnosis of invasive aspergillosis, with a particular emphasis on recent exploration techniques.
侵袭性肺曲霉病是一种机会性真菌病，由于曲霉菌属的环境真菌，难以诊断。诊断工具即使越来越多，但在数量和有效性方面仍然有限。欧洲癌症研究与治疗组织/真菌病研究组（EORTC/MSG）和欧洲白血病感染会议（ECIL）发布的当前建议表明，收集流行病学、放射临床和生物学数据以有力推定支持曲霉病的诊断。因此，医学影像和血清半乳甘露聚糖抗原目前构成了筛查方法的基础，尽管它们在特异性方面都有一些局限性。（1→3）-β-D-葡聚糖是具有非常好的阴性预测价值的泛真菌血清标志物。实时PCR缺乏标准化，呼吸道标本的真菌培养有时不够敏感。组织学可以证实曲霉病的诊断，但免疫抑制患者并非总是能够进行活检。我们阐述了侵袭性曲霉病诊断的各种依据，特别强调了最近的探索技术。
