Murayama S Y, Hanazawa R, Yamaguchi H, Makimura K, Hashimoto K, Ueda G
Department of Microbiology and Immunology, Teikyo University School of Medicine, Tokyo, Japan.
Kekkaku. 1997 Feb;72(2):83-90.
Aspergillosis is an opportunistic infection caused by pathogenic Aspergillus species (spp.) and is a major hazard for immunocompromised patients and even for non-immunocompromised individuals. Clinical diagnosis of aspergillosis, especially invasive pulmonary aspergillosis (IPA) is difficult and is largely presumptive, typically based on spiking fevers not responding to antibiotics in a patient with the risk factors. It is well known that Aspergillus spp. can be only infrequently cultured from clinical specimens, and that the cultural examination is laborious and time-consuming. Moreover, positive culture from bronchoalveolar lavage or sputa is indicative, but not proof of infection. The criterion for diagnosis of pulmonary infection by aspergilli requires repeated isolation of the same species of Aspergillus from respiratory specimens. There have been some successful attempts using serological assays to detect circulating antibodies to Aspergillus spp. in the noninvasive form of the disease, but these are generally negative in an acute phase IPA patient. A currently available serodiagnostic kit, Pastrex Aspergillus is limited in clinical usefulness because of low sensitivity and specificity in spite of being simple and rapid. Contamination of clinical specimens with various saprophytic filamentous fungi other than aspergilli also often give false positive. Diagnostic methods using such molecular biological techniques, as polymerase chain reaction (PCR) have recently been employed to identify DNA from a number of pathogens when diagnostic means are limited. PCR is known as the most sensitive and specific technique by which to detect a specific DNA sequence. In this paper we have reviewed new genetic methods of diagnosing aspergillosis including PCR and in situ hybridization.
曲霉病是由致病性曲霉菌种引起的机会性感染，对免疫功能低下的患者甚至非免疫功能低下的个体都是一大危害。曲霉病的临床诊断，尤其是侵袭性肺曲霉病（IPA）很困难，很大程度上是推测性的，通常基于有风险因素的患者出现对抗生素无反应的高热。众所周知，曲霉菌种很少能从临床标本中培养出来，而且培养检查费力且耗时。此外，支气管肺泡灌洗或痰液培养阳性有指示意义，但不能证明感染。曲霉菌引起肺部感染的诊断标准要求从呼吸道标本中反复分离出同一种曲霉菌。已经有一些成功尝试使用血清学检测来检测疾病非侵袭形式下针对曲霉菌种的循环抗体，但在急性IPA患者中这些检测通常为阴性。目前可用的一种血清诊断试剂盒Pastrex Aspergillus尽管简单快速，但由于敏感性和特异性低，临床实用性有限。临床标本被曲霉菌以外的各种腐生性丝状真菌污染也常常导致假阳性。当诊断手段有限时，最近已采用聚合酶链反应（PCR）等分子生物学技术来鉴定多种病原体的DNA。PCR是检测特定DNA序列最敏感和特异的技术。在本文中，我们综述了诊断曲霉病的新基因方法，包括PCR和原位杂交。
