Saeki A, Ogawa K, Honda K, Ando T, Oishi T, Sasamoto M, Hara M, Miwa T, Takagi K
National Higashi-Nagoya Hospital, Aichi, Japan.
Kekkaku. 1996 Jun;71(6):407-13.
Non-invasive pulmonary aspergillosis is frequently seen in cases with cavity as sequela of tuberculosis. Diagnosis of non-invasive pulmonary aspergillosis is not easy except for cases whose chest X-ray findings show a typical fungus ball. How to diagnose pulmonary aspergillosis was studied in 21 patients who showed changes in the radiological findings of cavity as sequela of tuberculosis. We made sputum culture of Aspergillus, measurement of precipitin antibody titer to Aspergillus fumigatus and measurement of PASTOREX ASPERGILLUS in serum and sputum on the 21 patients (group A). PASTOREX ASPERGILLUS in sputum was evaluated in three grades: 1+ approximately 3+. We diagnosed 14 patients as pulmonary aspergillosis (PA group) among the 21 patients taking into account the chest X-ray findings and the results of the above-stated investigations. The types of chest X-ray findings of these 14 patients were fungus ball type (FB) in 2 patients, productive aspergilloma on the inner wall of a cavity (PAIC) in 8, mixed type with FB and PAIC in 2 and non-specific change in 2. However, there were 3 patients with the chest X-ray findings suggestive of PAIC in 7 patients (non-PA group) who were not diagnosed as pulmonary aspergillosis. Sputum culture were positive in 11 patients of PA group (79%) and negative in all patients of non-PA group. Precipitin antibody were positive in 8 patients of PA group (67%) and negative in all patients of non-PA group. PASTOREX ASPERGILLUS in serum were negative in all 21 patients. PASTOREX ASPERGILLUS in sputum were 3+ (+3) in all 14 patients of PA group and in 2 patients of non-PA group and 2+ (+2) in 2 patients of non-PA group. 12 patients of PA group were treated by antifungal agents and 11 patients responded well to the treatment. We also made sputum culture of Aspergillus and measurement of PASTOREX ASPERGILLUS in sputum on 14 patients (group B) who had respiratory diseases with stable cavities and 17 patients (group C) who had respiratory diseases without a cavity. In group B, sputum culture were positive in 1 patient and PASTOREX ASPERGILLUS in sputum were 3+ (+3) in 2 patients, 2+ (+2) in 1 and 1+ (+) in 2. In group C, sputum culture were negative in all patients and PASTOREX ASPERGILLUS in sputum were 3+ (+3) in 1 patient, 2+ (+2) in 3 and 1+ (+) in 2. Measurement of PASTOREX in sputum was a useful tool to diagnose non-invasive aspergillosis in addition to sputum culture and measurement of precipitin antibody titer. The sensitivity of PASTOREX in sputum was high but its specificity was low, however, its specificity could be raised by applying semi-quantitative analysis of PASTOREX in sputum.
非侵袭性肺曲霉病常见于肺结核空洞形成的后遗症患者中。除胸部X线表现为典型真菌球的病例外，非侵袭性肺曲霉病的诊断并不容易。本研究对21例肺结核后遗症有空洞且影像学表现有变化的患者进行了肺曲霉病诊断方法的研究。我们对这21例患者（A组）进行了曲霉痰培养、烟曲霉沉淀素抗体滴度测定以及血清和痰液中的PASTOREX ASPERGILLUS检测。痰液中的PASTOREX ASPERGILLUS分为三个等级评估：1+至3+。综合胸部X线表现及上述检查结果，在这21例患者中，我们诊断出14例为肺曲霉病（PA组）。这14例患者的胸部X线表现类型为：真菌球型（FB）2例，空洞内壁增殖性曲霉球（PAIC）8例，FB与PAIC混合型2例，非特异性改变2例。然而，在7例胸部X线表现提示为PAIC但未被诊断为肺曲霉病的患者（非PA组）中有3例。PA组11例患者（79%）痰培养阳性，非PA组所有患者痰培养均为阴性。PA组8例患者（67%）沉淀素抗体阳性，非PA组所有患者沉淀素抗体均为阴性。21例患者血清中的PASTOREX ASPERGILLUS均为阴性。PA组14例患者及非PA组2例患者痰液中的PASTOREX ASPERGILLUS为3+（+3），非PA组2例患者痰液中的PASTOREX ASPERGILLUS为2+（+2）。PA组12例患者接受抗真菌药物治疗，11例患者治疗反应良好。我们还对14例有空洞且病情稳定的呼吸系统疾病患者（B组）和17例无空洞的呼吸系统疾病患者（C组）进行了曲霉痰培养及痰液中的PASTOREX ASPERGILLUS检测。B组中，1例患者痰培养阳性，2例患者痰液中的PASTOREX ASPERGILLUS为3+（+3），1例为2+（+2），2例为1+（+）。C组中，所有患者痰培养均为阴性，1例患者痰液中的PASTOREX ASPERGILLUS为3+（+3），3例为2+（+2），2例为1+（+）。除痰培养和沉淀素抗体滴度测定外，痰液中PASTOREX检测是诊断非侵袭性曲霉病的有用方法。痰液中PASTOREX检测的敏感性较高但其特异性较低，不过通过对痰液中PASTOREX进行半定量分析可提高其特异性。
