Characterization of patients with chronic pulmonary aspergillosis according to the new ESCMID/ERS/ECMM and IDSA guidelines

Abstract

Recently, the Infectious Diseases Society of America (IDSA) and the European Society for Clinical Microbiology and Infectious Diseases (ESCMID) in cooperation with the European Respiratory Society (ERS) and the European Confederation of Medical Mycology (ECMM) published guidelines for the diagnosis of chronic pulmonary aspergillosis (CPA). Both guidelines, however, carry significant differences. We retrospectively applied the diagnostic recommendations on a patient cohort of 71 previously diagnosed CPA patients in order to compare both guidelines. In 50 patients (70%) the diagnosis was confirmed by the diagnostic criteria of both guidelines, while nine patients (13%) fulfilled neither the ESCMID/ERS/ECMM nor the IDSA criteria. Reasons were lack of mycological evidence in respiratory samples. These patients were not tested for the presence of Aspergillus-specific IgG antibodies, which is strongly recommended by both guidelines. Seven patients did not fulfil the diagnostic criteria of the IDSA guideline, because of severe immunosuppression, while five patients didn't fulfil the diagnostic criteria of the ESCMID/ERS/ECMM guideline, because of uncommon image findings. The comparison of both guidelines highlight that the combination of a chest CT scan with the performance of an Aspergillus-specific IgG antibody assay are key diagnostic features to establish a guideline-based diagnosis of CPA.

The early diagnostic value of serum galactomannan antigen test combined with chest computed tomography for invasive pulmonary aspergillosis in pediatric patients after hematopoietic stem cell transplantation

“…Chest CT scan is a recommended modality method for diagnosing of IPA, 17 which is important for determination of IPA subtypes, and it is of direct significance for disease management. 18 F I G U R E 2 Receiver operating characteristic curves analyses on serum GM combined with CT scan for the diagnosis of IPA.…”

An Unexpected Endobronchial Mass Appearing During Bronchoscopy

“…Chronic pulmonary aspergillosis (CPA) is usually found in immunocompetent patients with underlying respiratory disorders as demonstrated by the patient, who had a history of pulmonary TB and a severe obstructive airway disease presumably associated with active cigarette smoking. 1 Clinical presentation of CPA can vary considerably from asymptomatic to lifethreatening hemoptysis (Table 1). Respiratory and general symptoms are not specific and commonly overlap with symptoms caused by the underlying respiratory disease.…”

Diagnosis and Management of Systemic Endemic Mycoses Causing Pulmonary Disease

“…Treatment monitoring and patient follow-up are essential to detect antifungal side effects, drug-drug interactions, treatment failure, and pulmonary sequelae. Long-term sequelae such as chronic pulmonary aspergillosis should be considered in patients with cavitary destruction of lung parenchyma [12,57]. Symptoms may persist for several months and a lung function test (usually showing an obstructive pattern) may help to monitor the course of disease.…”