Lass-Flörl Cornelia
Division of Hygiene and Medical Microbiology, Medical University of Innsbruck, Schöpfstraße 41, 6020 Innsbruck/Austria.
Med Mycol. 2019 Apr 1;57(Supplement_2):S155-S160. doi: 10.1093/mmy/myy103.
Aspergillosis is more common among immunocompromised patients with neutropenia or immunosuppression due to corticosteroid use, and infections are typically of the lung or sinuses. For diagnosis, broncholaveolar lavages (BALs) and lung biopsies are the specimens of choice. Culture and microscopic examinations are a must have and laboratory results should immediately be reported to the clinic. Fungal elements (hyphae) display the proof of an infection if present in primarily steril specimens, independent of culture results. Microscopy should be performed preferably using optical brighteners and histopathology using Gomori's methenamine silver stain or Periodic acid-Schiff. Serum and BAL galactomannan assays are recommended as markers for the diagnosis of invasive aspergillosis, PCR should be considered in conjunction with other diagnostic tests. Antifungal treatment decreases GM sensitivity. Pathogen identification to species complex level is strongly recommended for all clinically relevant Aspergillus isolates.
曲霉病在因中性粒细胞减少或使用皮质类固醇导致免疫抑制的免疫功能低下患者中更为常见，感染通常发生在肺部或鼻窦。对于诊断，支气管肺泡灌洗（BAL）和肺活检是首选标本。培养和显微镜检查是必需的，实验室结果应立即报告给临床。如果在主要无菌的标本中存在真菌成分（菌丝），则显示有感染证据，与培养结果无关。显微镜检查最好使用荧光增白剂，组织病理学检查使用Gomori六胺银染色或过碘酸希夫染色。血清和BAL半乳甘露聚糖检测推荐作为侵袭性曲霉病诊断的标志物，PCR应结合其他诊断测试考虑。抗真菌治疗会降低GM敏感性。强烈建议对所有临床相关的曲霉分离株进行到种复合体水平的病原体鉴定。
