Waqas Sarmad, Dunne Katie, Talento Alida Fe, Wilson Graham, Martin-Loeches Ignacio, Keane Joseph, Rogers Thomas R
Department of Clinical Medicine, Trinity College Dublin, Ireland.
Department of Clinical Microbiology, Trinity College Dublin, Ireland.
Med Mycol. 2020 Sep 14. doi: 10.1093/mmy/myaa077.
Chronic obstructive pulmonary disease (COPD) patients have been recognized to be at increased risk of Aspergillus spp. colonization, which may progress to invasive pulmonary aspergillosis (IPA). The objective of this study was to determine the frequency of Aspergillus colonization, or disease, in a cohort of COPD patients. A prospective observational study was undertaken to determine Aspergillus colonization, or disease, in consecutive COPD patients undergoing bronchoscopy. Fungal culture as well as galactomannan antigen (GM) and Aspergillus nucleic acid detection (PCR) were performed on bronchoalveolar lavage fluid (BAL) samples. One hundred and fifty patients were recruited. One hundred and twelve (74.7%) were outpatients, 38 (25.33%) were inpatients, of whom 6 (4%) were in the intensive care unit. Most patients (N = 122, 81.3%) were either COPD GOLD (Global Initiative for Chronic Obstructive Lung Disease) stages 1 or 2. Nine (6%) patients were on systemic steroids, 64 (42.7%) on inhaled steroids, and 9 (6%) on both. Seventeen patients (11.3%) had at least one positive test for Aspergillus detection (culture ± galactomannan ± polymerase chain reaction [PCR]), 13 (76.4%) of whom were COPD GOLD stages 1 or 2. Five patients had probable or putative IPA. Aspergillus sp. was detected in five patients (3.3%) by culture, but detection increased to 17 (11.3%) by the additional testing for GM or Aspergillus DNA. The frequency of Aspergillus detection in this cohort of COPD patients may reflect the predominance of early GOLD stages among the study population but deserves further investigation to determine its relevance as a predictive risk factor for IPA.
COPD is a risk factor for Aspergillus spp. colonization. Bronchoalveolar lavage samples of 150 COPD patients were tested for presence of Aspergillus fumigatus, which was detected in five patients (3.3%) by culture, but detection of Aspergillus increased to 17 (11.3%) by additional GM and PCR testing.
慢性阻塞性肺疾病（COPD）患者被认为感染曲霉属真菌的风险增加，这可能会发展为侵袭性肺曲霉病（IPA）。本研究的目的是确定一组COPD患者中曲霉定植或疾病的发生率。开展了一项前瞻性观察性研究，以确定连续接受支气管镜检查的COPD患者中的曲霉定植或疾病情况。对支气管肺泡灌洗（BAL）液样本进行真菌培养以及半乳甘露聚糖抗原（GM）和曲霉核酸检测（PCR）。招募了150名患者。其中112名（74.7%）为门诊患者，38名（25.33%）为住院患者，其中6名（4%）在重症监护病房。大多数患者（N = 122，81.3%）为COPD全球倡议（GOLD）1期或2期。9名（6%）患者使用全身性激素，64名（42.7%）使用吸入性激素，9名（6%）两者都用。17名患者（11.3%）至少有一项曲霉检测呈阳性（培养±半乳甘露聚糖±聚合酶链反应[PCR]），其中13名（76.4%）为COPD GOLD 1期或2期。5名患者可能患有或疑似患有IPA。通过培养在5名患者（3.3%）中检测到曲霉属真菌，但通过GM或曲霉DNA的额外检测，检测率增至17名（11.3%）。该组COPD患者中曲霉的检测频率可能反映了研究人群中早期GOLD分期的优势，但值得进一步研究以确定其作为IPA预测风险因素的相关性。
COPD是曲霉属真菌定植的危险因素。对150名COPD患者的支气管肺泡灌洗样本进行烟曲霉检测，通过培养在5名患者（（%）中检测到，通过GM和PCR额外检测后，曲霉的检测率增至17名（11.3%）。
