Kurita Takashi, Okamoto Koh, Sekiya Noritaka, Hanazawa Ryoichi, Yamamoto Akio, Hosoya Tadashi, Hirakawa Akihiro, Yasuda Shinsuke, Gu Yoshiaki
Department of Infectious Diseases, Institute of Science Tokyo, Tokyo 113-8510, Japan.
Center for Infectious Disease Education and Analysis (TCIDEA), Institute of Science Tokyo, Tokyo 113-8510, Japan.
J Fungi (Basel). 2025 Jun 7;11(6):437. doi: 10.3390/jof11060437.
The EORTC/MSGERC definition lacks sufficient sensitivity for diagnosing invasive pulmonary aspergillosis (IPA) in patients with autoimmune inflammatory rheumatic diseases (AIIRDs). We hypothesized that the partial fulfillment of the EORTC/MSGERC definition can improve its diagnostic sensitivity. This retrospective observational study included patients with AIIRDs on immunosuppressive therapy who underwent serum galactomannan antigen testing for suspected IPA. Patients who fulfilled the clinical features or mycological evidence as per the EORTC/MSGERC definition were considered as having "potential IPA." We compared the clinical characteristics of 364 patients who were categorized into 3 groups-potential IPA (n = 29), proven/probable IPA (n = 24), and non-IPA (n = 311; not meeting any definition). The potential and proven/probable IPA groups had significantly lower survival rates than the non-IPA group ( < 0.001). The potential IPA (adjusted hazard ratio [aHR], 2.0; 95% confidence interval [CI], 1.1-3.8) and proven/probable IPA (aHR, 2.6; 95% CI, 1.4-4.9) were independent risk factors for mortality. Compared with the EORTC/MSGERC definition, our proposed criteria improved sensitivity based on the diagnosis at the end of observation (50.0%, 100.0%, respectively). The characteristics and mortality rates of patients were similar between the potential and proven/probable IPA groups. Using these criteria for clinical diagnosis may provide high sensitivity.
欧洲癌症研究与治疗组织/侵袭性真菌感染协作组（EORTC/MSGERC）的定义在诊断自身免疫性炎性风湿性疾病（AIIRDs）患者的侵袭性肺曲霉病（IPA）时缺乏足够的敏感性。我们假设部分满足EORTC/MSGERC定义可提高其诊断敏感性。这项回顾性观察性研究纳入了接受免疫抑制治疗的AIIRDs患者，这些患者因疑似IPA接受了血清半乳甘露聚糖抗原检测。根据EORTC/MSGERC定义满足临床特征或真菌学证据的患者被视为患有“潜在IPA”。我们比较了364例患者的临床特征，这些患者被分为3组——潜在IPA组（n = 29）、确诊/疑似IPA组（n = 24）和非IPA组（n = 311；不符合任何定义）。潜在IPA组和确诊/疑似IPA组的生存率显著低于非IPA组（P < 0.001）。潜在IPA（调整后风险比[aHR]，2.0；95%置信区间[CI]，1.1 - 3.8）和确诊/疑似IPA（aHR，2.6；95%CI，1.4 - 4.9）是死亡的独立危险因素。与EORTC/MSGERC定义相比，我们提出的标准在观察结束时基于诊断提高了敏感性（分别为50.0%、100.0%）。潜在IPA组和确诊/疑似IPA组患者的特征和死亡率相似。使用这些标准进行临床诊断可能具有较高的敏感性。
