Takazono Takahiro, Izumikawa Koichi
Department of Infectious Diseases, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan.
Second Department of Internal Medicine, Nagasaki University Hospital, Nagasaki, Japan.
Front Microbiol. 2018 Aug 17;9:1810. doi: 10.3389/fmicb.2018.01810. eCollection 2018.
The diagnosis of chronic pulmonary aspergillosis (CPA) is occasionally complicated due to poor sensitivity of mycological culture and colonization of species in the airway. Several diagnostic methods have been developed for the diagnosis of invasive pulmonary aspergillosis; however, their interpretation and significance are different in CPA. This study aimed to review the recent advances in diagnostic methods and their characteristics in the diagnosis of CPA. Radiological findings of lung, histopathology, and culture are the gold standard of CPA diagnosis. Serodiagnosis methods involving the use of galactomannan and β-D-glucan have low sensitivity and specificity. An -specific IgG antibody assay showed good performance and had better sensitivity and reproducibility than conventional precipitant antibody assays. Currently, it is the most reliable method for diagnosing CPA caused by , but evidence on its effectiveness in diagnosing CPA caused by is lacking. Newly developed lateral flow device Aspergillus and detection of volatile organic compounds in breath have potential, but evidence on its effectiveness in diagnosing CPA is lacking. The increasing prevalence of azole-resistant strains has become a threat to public health. Some of the azole-resistant-related genes can be detected directly from clinical samples using a commercially available kit. However, its clinical efficacy for routine use remains unclear, since resistance-related genes greatly differ among regions and countries. Several issues surrounding the diagnosis of CPA remain unclear. Hence, further investigations and clinical studies are needed to improve the accuracy and efficiency of CPA diagnosis.
慢性肺曲霉病（CPA）的诊断偶尔会因真菌培养敏感性差以及气道中菌种定植而变得复杂。已经开发了几种用于诊断侵袭性肺曲霉病的诊断方法；然而，它们在CPA中的解读和意义有所不同。本研究旨在综述CPA诊断方法的最新进展及其特点。肺部的影像学表现、组织病理学和培养是CPA诊断的金标准。涉及使用半乳甘露聚糖和β-D-葡聚糖的血清学诊断方法敏感性和特异性较低。一种特异性IgG抗体检测表现良好，比传统沉淀抗体检测具有更好的敏感性和可重复性。目前，它是诊断由[具体菌种]引起的CPA最可靠的方法，但缺乏其在诊断由[具体菌种]引起的CPA有效性的证据。新开发的侧向流动装置曲霉检测和呼出气体中挥发性有机化合物的检测具有潜力，但缺乏其在诊断CPA有效性的证据。耐唑类[具体菌种]菌株的患病率不断上升已成为对公共卫生的威胁。一些与耐唑类相关的基因可以使用市售试剂盒直接从临床样本中检测到。然而，其常规使用的临床疗效仍不清楚，因为耐药相关基因在不同地区和国家差异很大。围绕CPA诊断的几个问题仍不明确。因此，需要进一步的研究和临床研究来提高CPA诊断的准确性和效率。
