Hopwood V, Johnson E M, Cornish J M, Foot A B, Evans E G, Warnock D W
Department of Microbiology, General Infirmary, University of Leeds.
J Clin Pathol. 1995 Mar;48(3):210-3. doi: 10.1136/jcp.48.3.210.
To evaluate the Pastorex aspergillus antigen latex agglutination test for the diagnosis of invasive aspergillosis in patients undergoing liver or bone marrow transplantation.
Serum samples were taken at least twice weekly post-transplant and tested for Aspergillus antigen. Latex agglutination test results were compared with microbiological examination of respiratory, urine and bile specimens. Serum samples from liver transplant patients were also tested for antibodies to Aspergillus fumigatus by counter immunoelectrophoresis.
Eight of the 91 patients studied developed invasive aspergillosis. Positive latex agglutination tests were obtained in eight of 187 (4.3%) serum samples from four of these eight patients. The other four patients with invasive aspergillosis gave consistently negative latex agglutination tests. A positive latex agglutination test was the first indication of invasive aspergillosis in two patients; these patients were already on amphotericin B. Positive latex agglutination tests were the only evidence of invasive aspergillosis in one patient who subsequently died of the infection. False positive latex agglutination tests were obtained in five of 83 (6%) patients with no evidence of invasive aspergillosis and misleading positive cultures seen in nine of 83 (10.8%). No antibodies were detected in three of four liver transplant patients with invasive aspergillosis. Conversely, antibodies were detected in 63 of 262 (24%) serum samples from 43 liver transplant patients with no evidence of invasive aspergillosis; one of these patients had an antibody titre of 1:2 on four separate occasions.
The Pastorex aspergillus antigen latex agglutination test, when used alone, lacks sensitivity and specificity for the early diagnosis of invasive aspergillosis. A diagnosis was made in all patients with invasive aspergillosis when both culture and antigen tests were performed although using these criteria a false positive diagnosis would have been made in 13 of 83 (15.6%) patients. Microbiological and serial serological investigations for antigen should both be performed and the results considered in conjunction with radiological and clinical evidence.
评估Pastorex曲霉抗原乳胶凝集试验在肝移植或骨髓移植患者侵袭性曲霉病诊断中的应用价值。
移植后每周至少采集两次血清样本，检测曲霉抗原。乳胶凝集试验结果与呼吸道、尿液和胆汁标本的微生物学检查结果进行比较。还通过对流免疫电泳检测肝移植患者血清样本中烟曲霉抗体。
91例研究患者中有8例发生侵袭性曲霉病。这8例患者中4例的187份血清样本中有8份（4.3%）乳胶凝集试验呈阳性。其他4例侵袭性曲霉病患者的乳胶凝集试验始终为阴性。2例患者乳胶凝集试验阳性是侵袭性曲霉病的首个迹象；这2例患者当时已在接受两性霉素B治疗。1例随后死于该感染的患者，乳胶凝集试验阳性是侵袭性曲霉病的唯一证据。83例无侵袭性曲霉病证据的患者中有5例（6%）乳胶凝集试验出现假阳性，83例中有9例（10.8%）培养结果出现误导性阳性。4例侵袭性曲霉病肝移植患者中有3例未检测到抗体。相反，262份血清样本中有63份（24%）来自43例无侵袭性曲霉病证据的肝移植患者，其中1例患者在4个不同时间点抗体滴度均为1:2。
单独使用Pastorex曲霉抗原乳胶凝集试验对侵袭性曲霉病的早期诊断缺乏敏感性和特异性。对所有侵袭性曲霉病患者进行培养和抗原检测时均能做出诊断，不过按照这些标准，83例患者中有13例（15.6%）会被误诊为假阳性。应同时进行微生物学和系列血清学抗原检测，并结合影像学和临床证据综合考虑检测结果。
