Department of Parasitology-Mycology, University Hospital of Besançon, Besancon, France.
Referent Laboratory of Medical Biology for the serological diagnosis of hypersensitivity pneumonitis (LBMR PHS), University Hospital of Besançon, Besancon, France.
Med Mycol. 2022 May 28;60(5). doi: 10.1093/mmy/myac031.
Although a high prevalence of COVID-19-associated pulmonary aspergillosis has been reported, it is still difficult to distinguish between colonization with Aspergillus fumigatus and infection. Concomitantly, similarities between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and hypersensitivity pneumonitis were suggested. The objective of this study was to investigate retrospectively if precipitin assays targeting A. fumigatus could have been useful in the management of SARS-CoV-2 patients hospitalized in an Intensive Care Unit (ICU) in 2020. SARS-CoV-2 ICU patients were screened for Aspergillus co-infection using biomarkers (galactomannan antigen, qPCR) and culture of respiratory samples (tracheal aspirates and bronchoalveolar lavage). For all these patients, clinical data, ICU characteristics and microbial results were collected. Electrosyneresis assays were performed using commercial A. fumigatus somatic and metabolic antigens. ELISA were performed using in-house A. fumigatus purified antigen and recombinant antigens.Our study population consisted of 65 predominantly male patients, with a median ICU stay of 22 days, and a global survival rate of 62%. Thirty-five patients had at least one positive marker for Aspergillus species detection. The number of arcs obtained by electrosyneresis using the somatic A. fumigatus antigen was significantly higher for these 35 SARS-CoV-2 ICU patients (P 0.01, Welch's t-test). Our study showed that SARS-CoV-2 ICU patients with a positive marker for Aspergillus species detection more often presented precipitins towards A. fumigatus. Serology assays could be an additional tool to assess the clinical relevance of the Aspergillus species in respiratory samples of SARS-CoV-2 ICU patients.
This study showed retrospectively that precipitin assays, such as electrosyneresis, could be helpful to distinguish between colonization and infection with Aspergillus fumigatus during the management of severe acute respiratory syndrome Coronavirus-2 (SARS CoV-2) patients in an intensive care unit.
虽然有报道称 COVID-19 相关肺曲霉病的患病率很高，但仍难以区分烟曲霉的定植和感染。同时，有人提出严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）与过敏性肺炎之间存在相似性。本研究的目的是回顾性调查 2020 年在重症监护病房（ICU）住院的 SARS-CoV-2 患者中，针对烟曲霉的沉淀素检测是否对其治疗有用。使用生物标志物（半乳甘露聚糖抗原、qPCR）和呼吸道样本（气管吸出物和支气管肺泡灌洗）培养对 SARS-CoV-2 ICU 患者进行曲霉属合并感染筛查。对所有这些患者，收集临床数据、ICU 特征和微生物结果。使用商业烟曲霉体细胞和代谢抗原进行电泳免疫扩散检测。使用内部纯化的烟曲霉抗原和重组抗原进行 ELISA。我们的研究人群由 65 名主要为男性患者组成，中位 ICU 入住时间为 22 天，整体存活率为 62%。35 名患者至少有一项曲霉属检测阳性标志物。使用烟曲霉体细胞抗原进行电泳免疫扩散获得的弧数对于这 35 名 SARS-CoV-2 ICU 患者明显更高（P<0.01，Welch's t 检验）。我们的研究表明，SARS-CoV-2 ICU 患者中，有曲霉属检测阳性标志物的患者更常针对烟曲霉产生沉淀素。血清学检测可能是评估 SARS-CoV-2 ICU 患者呼吸道样本中曲霉属临床相关性的另一种工具。
本研究回顾性表明，在重症监护病房 SARS-CoV-2 患者的治疗中，沉淀素检测（如电泳免疫扩散）有助于区分烟曲霉的定植和感染。
