Aspergillus-Nachweis im Atemwegsmaterial

Abstract

Fungi of the genus Aspergillus are ubiquitously present. Even though humans inhale Aspergillus spores daily under natural conditions, Aspergillus-associated pulmonary diseases only occur under special circumstances. Whether an Aspergillus-associated disease develops and which type of Aspergillus-associated disease develops depends on the constitution of the host. The spectrum of Aspergillus-associated pulmonary diseases ranges from allergic diseases, such as hypersensitivity pneumonitis to allergic infectious diseases, such as allergic bronchopulmonary aspergillosis (ABPA) and bronchocentric granulomatosis (BG) to infectious diseases, such as invasive (IA) or semi-invasive aspergillosis (SIA) and chronic pulmonary aspergillosis (CPA). Identification of Aspergillus spp. from sputum or bronchopulmonary secretions is not sufficient for a definitive diagnosis of Aspergillus-associated infections. The gold standard is the identification of Aspergillus spp. from lung tissue by culture or by histopathological methods; however, in clinical practice the decision to initiate antifungal therapy is more often based on immunological methods, such as the detection of Aspergillus-specific IgG antibodies from peripheral blood or galactomannan antigens from bronchoalveolar lavages. Acute IA or SIA infections have a high mortality and require immediate antifungal therapy. With rare exceptions CPA cannot be cured by medicinal therapy alone; however, active CPA can be brought into remission with antifungal therapy. Eradication of Aspergillus in CPA can as a rule only be successful using a combined antimycotic and surgical intervention.

Diagnosis of Breakthrough Fungal Infections in the Clinical Mycology Laboratory: An ECMM Consensus Statement

“…Data on the performance of the new lateral flow tests for the diagnosis of breakthrough IA, such as the AspLFD (OLM Diagnostics, Newcastle upon Tyne, UK; herein LFD) and the sōna Aspergillus galactomannan LFA (IMMY, Norman, OK, USA; herein LFA), are limited. For the LFD prototype test, sensitivity in BALF was only 52% in those receiving mold-active antifungals versus 86% in those not receiving mold-active antifungals [68], with a similar impact shown for serum LFD results in an animal model [27]. For the LFA, so far limited data has shown no significant impact of mold-active antifungals on efficacy [57,[71][72][73][74].…”

“…Slightly reduced sensitivities in the presence of mold-active antifungals has also been described for the BAL GM: at a cut-off of 0.5 optical density index (ODI), Eigl and colleagues showed a 71% sensitivity for probable/proven IA in those on antifungals versus 95% in those without antifungals [7,67,68]. Sensitivity for diagnosing breakthrough IA in patients on antifungal prophylaxis dropped to 52% in that study when using a 1.0 ODI cutoff [68]. Therefore, using a lower cut-off of 0.5 ODI from BALF for diagnosing breakthrough IA may be preferable and was also recommended in another study [67].…”

“…In general, the sensitivity of serum GM assay to detect probable and proven IA is 81.8%, but none of patients with IA and a posaconazole concentration ≥ 0.5 mg/L had a positive serum GM test [66]. Slightly reduced sensitivities in the presence of mold-active antifungals has also been described for the BAL GM: at a cut-off of 0.5 optical density index (ODI), Eigl and colleagues showed a 71% sensitivity for probable/proven IA in those on antifungals versus 95% in those without antifungals [7,67,68]. Sensitivity for diagnosing breakthrough IA in patients on antifungal prophylaxis dropped to 52% in that study when using a 1.0 ODI cutoff [68].…”

CPAnet Registry—An International Chronic Pulmonary Aspergillosis Registry

“…Adult patients with a diagnosis of CPA are included either prospectively or retrospectively. The population is selected based on the following four diagnostic criteria [ 1 , 15 ]: (1) Radiology: one or more cavities with or without a fungal ball present or nodules on thoracic imaging; (2) Mycology: any direct or indirect mycological evidence from respiratory samples or from blood of Aspergillus spp. infection; (3) Differential diagnosis: exclusion of an alternative diagnosis (e.g., lung cancer); (4) Chronic disease: disease present for at least 3 months (e.g., chronic respiratory symptoms ≥3 months or available follow-up images with CPA features ≥3 months).…”

Pulmonary Diseases in Refugees and Migrants in Europe

“…The diagnosis is made by a combination of radiological, clinical, and mycological criteria [76]. Beside an Aspergillus IgG antibody test from serum, bronchoscopy should be performed in all patients, depending on a risk/benefit assessment to prove mycological evidence and to exclude alternative diagnoses [77]. Itraconazole (200 mg b.i.d.)…”