Abstract
The aim of this study was to determine the significance of isolation of Aspergillus fumigatus from cultures of respiratory specimens in nongranulocytopenic patients. The medical records of patients with respiratory specimens positive for Aspergillus fumigatus who were admitted to an adult pneumology ward were reviewed during a 2-year period. A total of 80 respiratory specimens from 76 patients yielded Aspergillus fumigatus. Forty-eight patients were colonized with Aspergillus fumigatus, whereas the 28 (37%) remaining patients had pulmonary aspergillosis, manifest as aspergilloma (n=19 patients), chronic necrotizing pulmonary aspergillosis (n=7 patients), and bronchial aspergillosis (n=2 patients). The presence of typical hyphae in direct examination of bronchoscopic specimens was more likely to be found in infected than in colonized patients (P=0.04). No immunological test was positive in colonized patients, whereas anti-Aspergillus antibodies were detected in 55% of infected patients (P<0.001). Pulmonary tuberculosis was the most common underlying lung disease in patients with aspergilloma, but it was not found in any patient with chronic necrotizing pulmonary aspergillosis (P=0.006). Anti-Aspergillus antibodies were more likely to be detected in patients with aspergilloma (78%) than in patients with chronic necrotizing pulmonary aspergillosis (14%) (P=0.007). The analysis of predisposing factors, in conjunction with immunological tests and examination of bronchoscopic specimens, is helpful in distinguishing between colonization and infection with Aspergillus fumigatus, as well as for differentiating between aspergilloma and chronic necrotizing pulmonary aspergillosis.
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References
Sharma OP, Chwogule R (1998) Many faces of pulmonary aspergillosis. Eur Respir J 12:705–715
Denning DW (1998) Invasive aspergillosis. Clin Infect Dis 26:781–805
Latgé JP (1999) Aspergillus fumigatus and aspergillosis. Clin Microbiol Rev 12:310–350
Saraceno JL, Phelps DT, Ferro TJ, Futerfas R, Schwartz DB (1997) Chronic necrotizing pulmonary aspergillosis: approach to management. Chest 112:541–548
Caras WE, Pluss JL (1996) Chronic necrotizing pulmonary aspergillosis: pathologic outcome after itraconazole therapy. Mayo Clin Proc 71:25–30
Horvarth JA, Dummer S (1996) The use of respiratory-tract cultures in the diagnosis of invasive pulmonary aspergillosis. Am J Med 100:171–178
Levy H, Horak DA, Tegtmeier BR, Yokota SB, Forman SJ (1992) The value of bronchoalveolar lavage and bronchial washings in the diagnosis of invasive pulmonary aspergillosis. Respir Med 86:243–248
Yu VL, Muder RR, Poorsattar A (1986) Significance of isolation of Aspergillus from the respiratory tract in diagnosis of invasive pulmonary aspergillosis. Am J Med 81:249–254
Nalesnik MA, Myerowitz RL, Jenkins R, Lenkey J, Herbert D (1980) Significance of Aspergillus species isolated from respiratory secretions in the diagnosis of invasive pulmonary aspergillosis. J Clin Microbiol 11:370–376
American Thoracic Society (1997) Diagnosis and treatment of disease caused by nontuberculous mycobacteria. Am J Resp Crit Care Med 156 [Suppl]:1–25
Broderick LS, Conces DJ Jr, Tarver RD, Bergmann CA, Bisesi MA (1996) Pulmonary aspergillosis: a spectrum of disease. Crit Rev Diagn Imaging 37:491–531
Gefter WB, Weingrad TR, Epstein DM, Ochs RH, Miller WT (1981) "Semi-invasive" pulmonary aspergillosis: a new look at the spectrum of Aspergillus infections of the lung. Radiology 140:313–321
Binder RE, Faling LJ, Pugatch RD, Mahasaen C, Snider GL (1982) Chronic necrotizing pulmonary aspergillosis: a discrete clinical entity. Medicine 61:109–124
Denning DW (1995) Commentary: unusual manifestations of aspergillosis. Thorax 50:812–813
Treger TR, Visscher DW, Bartlett MS, Smith JW (1985) Diagnosis of pulmonary infection caused by Aspergillus: usefulness of respiratory cultures. J Infect Dis 152:572–576
Bodey PG, Vartivarian S (1989) Aspergillosis. Eur J Clin Microbiol Infect Dis 8:413–437
Perfect JR, Cox YL, Lee JY, Kauffman CA, Repentigny L de, Chapman SW, Morrison VA, Pappas P, Hiemenz JW, Stevens DA (2001) The impact of culture isolation of Aspergillus species: a hospital-based survey of aspergillosis. Clin Infect Dis 33:1824–1833
Thompson BH, Stanford W, Galvin JR, Kurihara Y (1995) Varied radiologic appearances of pulmonary aspergillosis. Radiographics 15:1273–1284
Miller WT (1996) Aspergillosis: a disease with many faces. Semin Roentgenol 31:52–66
Yousem SA (1997) The histological spectrum of chronic necrotizing forms of pulmonary aspergillosis. Hum Pathol 28:650–656
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The authors would like to thank Prof G. Meyer for his helpful comments.
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This work was presented in part at the 5th Congress of the European Confederation of Medical Mycology, Dresden, Germany, 1999
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Uffredi, M.L., Mangiapan, G., Cadranel, J. et al. Significance of Aspergillus fumigatus Isolation from Respiratory Specimens of Nongranulocytopenic Patients. Eur J Clin Microbiol Infect Dis 22, 457–462 (2003). https://doi.org/10.1007/s10096-003-0970-y
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DOI: https://doi.org/10.1007/s10096-003-0970-y