Lachaud L, Gangneux J P
Laboratoire de parasitologie-mycologie, faculté de médecine de Montpellier-Nîmes, CHU de Montpellier, 39, avenue Charles-Flahault, 34295 Montpellier cedex 5, France.
Laboratoire de parasitologie-mycologie, CHU Pontchaillou, 2, rue Henri-Le-Guillou, 35033 Rennes cedex 09, France.
Rev Mal Respir. 2017 Dec;34(10):1114-1123. doi: 10.1016/j.rmr.2017.08.001. Epub 2017 Sep 15.
Pulmonary parasitic diseases are rare whereas pulmonary fungal infections are increasing. The diversity of clinical presentations requires laboratory tests to confirm the diagnosis. Direct examination of lung samples and antibody detection are the basis of parasitological diagnosis. With regard to mycoses, the range of biological tests is broader. The conventional mycological examination allows identification of any type of fungus except Pneumocystis jirovecii. Its specificity is excellent but it lacks sensitivity. Detection of antibodies, antigens or nucleic acid complements the diagnostic tools. With regard to aspergillosis, there is a broad nosological set with variable prognosis. The choice of appropriate laboratory procedures depends on the clinical presentation and patient risk factors. The search for galactomannan antigen is effective and a new technique, "Lateral Flow Device", seems very promising. The detection of antibodies is also informative but various techniques are used. A good knowledge of the performance and limitations of these techniques allows targeted prescription. The use of PCR for the diagnosis of pulmonary fungal infections has limited indications. Biological and clinical co-operation is essential for the choice and interpretation of laboratory tests for parasitic or fungal pulmonary disease.
肺部寄生虫病较为罕见,而肺部真菌感染却在增加。临床表现的多样性需要实验室检查来确诊。对肺样本的直接检查和抗体检测是寄生虫学诊断的基础。对于真菌病,生物学检测的范围更广。传统的真菌学检查能够鉴定除耶氏肺孢子菌之外的任何真菌类型。其特异性极佳,但缺乏敏感性。抗体、抗原或核酸检测补充了诊断手段。对于曲霉病,存在一系列病种,预后各异。选择合适的实验室检查程序取决于临床表现和患者的风险因素。检测半乳甘露聚糖抗原很有效,一项新技术“侧向流动装置”似乎很有前景。抗体检测也能提供信息,但使用了多种技术。充分了解这些技术的性能和局限性有助于有针对性地开具检查。使用聚合酶链反应(PCR)诊断肺部真菌感染的适应证有限。生物学和临床协作对于选择和解读寄生虫或真菌性肺部疾病的实验室检查至关重要。