Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK, Global Action Fund for Fungal Infections, Geneva, Switzerland.
Int J Tuberc Lung Dis. 2021 Jul 1;25(7):525-536. doi: 10.5588/ijtld.21.0053.
Significant innovations in the past decade have resulted in more sensitive and faster diagnosis of allergic, chronic and invasive pulmonary aspergillosis, as well as bronchitis and nodules. This new diagnostic landscape has revealed that the incidence and prevalence of aspergillosis is substantially higher than previously understood, and is summarised in this review. Oral and intravenous antifungal treatment offers good clinical response rates for affected patients. Nevertheless, missed diagnoses mean that patients are over-treated with antibacterial agents, corticosteroids and anti-TB drugs, resulting in continuing illness and often death. The clinical introduction of several high performing diagnostic tests is helping to redefine patient management. It is well-known that antigen can be detected in 70-95% of bronchoscopy samples in patients with invasive and chronic aspergillosis in less than 1 hour. immunoglobulin G (IgG) (precipitins) is >90% sensitive and >85% specific for chronic and allergic aspergillosis. High-volume respiratory fungal culture and polymerase chain reaction have 3-5-fold higher sensitivity than routine bacterial culture. IgE (or skin prick testing) diagnoses sensitisation in asthma, cystic fibrosis, chronic obstructive pulmonary disease and post-TB, and correlates well with poorer lung function and/or exacerbations. Clinicians and laboratorians across the world need to mainstream these excellent new tools to improve clinical outcomes by delivering results in a more timely and accurate fashion.
过去十年的重大创新使得过敏、慢性和侵袭性肺曲霉病以及支气管炎和结节的诊断更加敏感和快速。这一新的诊断领域表明，曲霉病的发病率和患病率远远高于先前的理解，本综述对此进行了总结。口服和静脉用抗真菌治疗为受影响的患者提供了良好的临床反应率。然而，漏诊意味着患者被过度使用抗菌药物、皮质类固醇和抗结核药物治疗，导致病情持续存在，并且经常导致死亡。几种高性能诊断测试的临床引入有助于重新定义患者管理。众所周知，抗原可以在不到 1 小时内检测到侵袭性和慢性曲霉病患者支气管镜样本中 70-95%的患者。免疫球蛋白 G（IgG）（沉淀素）对慢性和过敏性曲霉病的敏感性>90%，特异性>85%。大容量呼吸真菌培养和聚合酶链反应的灵敏度比常规细菌培养高 3-5 倍。IgE（或皮肤点刺试验）诊断哮喘、囊性纤维化、慢性阻塞性肺疾病和肺结核后致敏，与肺功能下降和/或恶化相关性良好。世界各地的临床医生和实验室人员需要将这些出色的新工具纳入主流，以更及时、更准确的方式提供结果，从而改善临床结果。
