Aspergillus fumigatus fungus ball in hospitalized patients with chronic pulmonary disease: usefulness of double immunodiffusion test as a screening procedure

Ferreira-da-Cruz, M. F.; Wanke, Bodo; Pirmez, Claude; Galvão–Castro, Bernardo

doi:10.1590/s0074-02761988000300013

Cited by 7 publications

(9 citation statements)

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“…New Aspergillus -specific antibodies developed in 9.8% and aspergilloma in 5.4% of patients during 2 years of follow-up, indicating an annual rate of aspergilloma development of 2.7%. Aspergillus -specific antibodies were found in 8.3% of 350 predominantly treated TB patients in Brazil [34], 23–25% of 77 Indian treated TB patients [35, 36], 19% of 226 Japanese patients with active or treated TB [37] and 9% of 101 HIV-positive patients completing pulmonary TB treatment in Kampala [38]. Chest radiography plus serology surveys have found probable CPA in 8.7% of 208 patients completing TB therapy in Nigeria [22] and 11.3% of 124 HIV-negative patents with active or treated TB in Iran [23].…”

Section: Discussionmentioning

confidence: 99%

Chronic pulmonary aspergillosis commonly complicates treated pulmonary tuberculosis with residual cavitation

et al. 2019

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Chronic pulmonary aspergillosis (CPA) complicates treated pulmonary tuberculosis (TB), with high 5-year mortality. We measured CPA prevalence in this group.398 Ugandans with treated pulmonary TB underwent clinical assessment, chest radiography and Aspergillus-specific IgG measurement. 285 were resurveyed 2 years later, including computed tomography of the thorax in 73 with suspected CPA. CPA was diagnosed in patients without active TB who had raised Aspergillus-specific IgG, radiological features of CPA and chronic cough or haemoptysis.Author-defined CPA was present in 14 (4.9%, 95% CI 2.8–7.9%) resurvey patients. CPA was significantly more common in those with chest radiography cavitation (26% versus 0.8%; p<0.001), but possibly less frequent in HIV co-infected patients (3% versus 6.7%; p=0.177). The annual rate of new CPA development between surveys was 6.5% in those with chest radiography cavitation and 0.2% in those without (p<0.001). Absence of cavitation and pleural thickening on chest radiography had 100% negative predictive value for CPA. The combination of raised Aspergillus-specific IgG, chronic cough or haemoptysis and chest radiography cavitation had 85.7% sensitivity and 99.6% specificity for CPA diagnosis.CPA commonly complicates treated pulmonary TB with residual chest radiography cavitation. Chest radiography alone can exclude CPA. Addition of serology can diagnose CPA with reasonable accuracy.

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Section: Discussionmentioning

confidence: 99%

Chronic pulmonary aspergillosis commonly complicates treated pulmonary tuberculosis with residual cavitation

et al. 2019

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“…In Brazil, studies on the prevalence of CPA in patients with PTB are scarce. In a cohort of 350 patients enrolled due to radiographic findings of chronic pulmonary disease, aspergillosis was confirmed by DID test in 29 (8.3%) patients, 27 of whom reported a past history of PTB 8 . Furthermore, the incidence of CPA in Brazil was estimated to be 6.2 cases per 100,000 inhabitants by the Leading International Fungal Education 42 .…”

Section: Discussionmentioning

confidence: 99%

“…Few studies have reported the prevalence of CPA in PTB and reported rates between 8.3% and 25.0% 8–10 . This variation occurs mainly due to the difficulty in establishing the diagnosis of CPA 3 …”

Section: Introductionmentioning

confidence: 99%

Prevalence of chronic pulmonary aspergillosis regarding time of tuberculosis diagnosis in Brazil

Chaves

Venturini

Castilho

et al. 2022

Mycoses

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Background Data on the prevalence of chronic pulmonary aspergillosis (CPA) in patients with active or cured tuberculosis (TB) are scarce, mainly due to diagnostic difficulties. The diagnosis of CPA is based on pulmonary symptoms and chest computed tomography (CT) scans and is considered confirmed when there is microbiological or serological evidence of Aspergillus spp. infection. Objectives To estimate the prevalence of CPA in patients treated or undergoing treatment for PTB, seen in two referral hospitals in Mato Grosso do Sul, Brazil. Patients and Methods A total of 193 consecutive patients who were treated or previously treated for pulmonary tuberculosis underwent prospective evaluation: (a) clinical evaluation; (b) chest CT scan; (c) sputum examination—culture for fungi and smears for direct mycology; (d) detection of anti‐Aspergillus fumigatus antibodies using an enzyme‐linked immunosorbent assay Platelia® test; and (e) anti‐Aspergillus spp. antibodies were assessed via a DID test. Results The global prevalence of CPA was 10.9% (95% confidence interval, 7.2%–16.1%), but it increased with the time of TB diagnosis. The variables independently associated with CPA were previous pulmonary tuberculosis over 4 years ago and haemoptysis. Cavities, pleural thickening and the presence of a fungal ball were the most frequent tomographic findings in patients with CPA. Conclusions The high prevalence observed and its increase over time suggest the need for continuous surveillance of CPA in patients with active or previous pulmonary tuberculosis and throughout life, with clinical, tomographic and serological evaluations (ELISA) for a timely diagnosis and a better prognosis.

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“…nidulans and A . terreus have been described, though with a predominance of the first [ 10 , 41 – 42 , 44 – 45 ].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the Double Agar Gel Immunodiffusion Test and of the Enzyme-Linked Immunosorbent Assay in the Diagnosis and Follow-Up of Patients with Chronic Pulmonary Aspergillosis

et al. 2015

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The diagnosis of chronic pulmonary aspergillosis (CPA) depends on the radiologic image and the identification of specific antibodies. The present study aimed to evaluate accuracy parameters of enzyme-linked immunosorbent assay (ELISA) and of the determination of serum galactomannan level in the diagnosis of patients with CPA, comparing these results with the double agar gel immunodiffusion (DID) test. In addition, the prevalence of cross-reactivity and the serological progression after treatment were evaluated by comparing DID and ELISA. Six study groups were formed: G1: 22 patients with CPA, 17 of whom had Aspergillus fungus ball, one chronic cavitary pulmonary aspergillosis (CCPA) and four chronic fibrosing pulmonary aspergillosis (CFPA); G2: 28 patients with pulmonary tuberculosis (TB); G3: 23 patients with histoplasmosis (HST); G4: 50 patients with paracoccidioidomycosis (PCM); G5: 20 patients with cryptococcosis (CRC); and G6: 200 healthy controls. Serum antibodies were measured by DID and ELISA, with two antigen preparations—Aspergillus fumigatus (DID1, ELISA1) and a pool of A. fumigatus, A. flavus and A. niger antigens (DID2, ELISA2). The Platélia Aspergillus Enzyme Immunoassay (EIA) kit was used to measure galactomannan. The cut-off points of ELISA were determined for each antigen preparation and for the 95% and 99% confidence intervals. Despite the low sensitivity, DID was the technique of choice due to its specificity, positive and negative predictive values and positive likelihood ratio–especially with the antigen pool and due to the low frequency of cross-reactivity. ELISA1 and a 0.090 cut-off showed high sensitivity, specificity and negative predictive value, but a high frequency of cross-reactivity with CRC. The best degree of agreement was observed between ELISA1 and ELISA2. The detection of serum galactomannan showed high sensitivity, comparable to ELISA2. The immunodiffusion test showed an excellent relationship with the progression after treatment, which made it the reaction of choice for patient follow-up.

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Aspergillus fumigatus fungus ball in hospitalized patients with chronic pulmonary disease: usefulness of double immunodiffusion test as a screening procedure

Cited by 7 publications

References 0 publications

Chronic pulmonary aspergillosis commonly complicates treated pulmonary tuberculosis with residual cavitation

Chronic pulmonary aspergillosis commonly complicates treated pulmonary tuberculosis with residual cavitation

Prevalence of chronic pulmonary aspergillosis regarding time of tuberculosis diagnosis in Brazil

Evaluation of the Double Agar Gel Immunodiffusion Test and of the Enzyme-Linked Immunosorbent Assay in the Diagnosis and Follow-Up of Patients with Chronic Pulmonary Aspergillosis

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