Department of Medicine, AIIMS, New Delhi, 110029, India.
Department of Microbiology, AIIMS, New Delhi, 110029, India.
Mycopathologia. 2023 Dec;188(6):1041-1053. doi: 10.1007/s11046-023-00797-z. Epub 2023 Oct 20.
The diagnosis of chronic pulmonary aspergillosis (CPA) is established by combined clinic-radio-microbiological criteria. Out of the different microbiological criteria, a positive serology for Aspergillus-specific IgG levels is the cornerstone of diagnosis. Alternatively, other microbiological evidence are sometimes sought viz., positive Aspergillus antigen (broncho-alveolar lavage fluid, i.e., BALF galactomannan ≥ 1.0), histopathological demonstration of the fungi following lung biopsy or resection, demonstration of hyaline septate hyphae in direct microscopy resembling Aspergillus spp. or its growth on a respiratory specimen. However, the exact roles of BALF- GM and the newer BALF-PCR have not been confirmed by studies till date. This study enrolled 210 patients with suspected CPA. Of the participants, 88 patients met the criteria for CPA, whereas 122 patients had an alternative diagnosis. The sensitivity-specificity of AsperGenius® PCR and "in-house" PCR were 52.27(36.69-67.54) %-33.78 (23.19-45.72) % and 36.36 (22.41-52.23) %-39.19 (28.04-51.23) % respectively. The sensitivity/specificity of BALF (> 1.0) and serum galactomannan (> 1.0) were 46.55% (33.34-60.13)/64.08% (54.03-73.3) and 29.82% (22.05-37.6)/86.84% (81.1-92.59) respectively. The optimal cut-off values for BALF-Galactomannan and serum galactomannan in diagnosing CPA were found to be 0.69 (sensitivity: 64%; specificity: 53%) and 0.458 (sensitivity: 67%; specificity: 64%) respectively. This results of this study suggests that Aspergillus PCR from BAL may not be a good "rule-in" test for diagnosing CPA. While the performances of GM in BAL and serum may be better than PCR, it should be best used in conjunction with other clinical, radiological, and other microbiological characteristics.
慢性肺曲霉病（CPA）的诊断通过结合临床-放射-微生物学标准来确立。在不同的微生物学标准中，曲霉特异性 IgG 水平的阳性血清学检测是诊断的基石。或者，有时会寻找其他微生物学证据，例如阳性曲霉抗原（支气管肺泡灌洗液，即 BALF 半乳甘露聚糖≥1.0）、肺活检或切除后真菌的组织病理学表现、直接镜检中类似于曲霉属的透明分隔菌丝或其在呼吸道标本上的生长。然而，BALF-GM 和更新的 BALF-PCR 的确切作用尚未被研究证实。本研究纳入了 210 名疑似 CPA 的患者。其中，88 名患者符合 CPA 标准，而 122 名患者有其他诊断。AsperGenius® PCR 和“内部”PCR 的敏感性-特异性分别为 52.27（36.69-67.54）%-33.78（23.19-45.72）%和 36.36（22.41-52.23）%-39.19（28.04-51.23）%。BALF（>1.0）和血清半乳甘露聚糖（>1.0）的敏感性/特异性分别为 46.55%（33.34-60.13）/64.08%（54.03-73.3）和 29.82%（22.05-37.6）/86.84%（81.1-92.59）。诊断 CPA 的 BALF-半乳甘露聚糖和血清半乳甘露聚糖的最佳临界值分别为 0.69（敏感性：64%；特异性：53%）和 0.458（敏感性：67%；特异性：64%）。本研究结果表明，BAL 中的曲霉 PCR 可能不是诊断 CPA 的良好“纳入”试验。虽然 BAL 和血清中的 GM 性能可能优于 PCR，但最好与其他临床、放射学和其他微生物学特征一起使用。
