Immunity status of invasive pulmonary aspergillosis patients with structural lung diseases in Chinese adults

Abstract

Background: Invasive pulmonary aspergillosis (IPA) is a fungal infection frequently observed in patients with immune dysfunction, such as those suffering from structural lung diseases. Nevertheless, studies assessing IPA combined with other common respiratory diseases remain scarce, particularly those regarding the immune status of its patients. Different structural lung diseases are known to differently affect patient immune status; however, the mechanisms by which this is conferred have yet to be determined. Thus, our study aims to compare the immune status of IPA patients with the structural lung diseases chronic obstructive pulmonary diseases (COPD), interstitial lung disease (ILD) and non-cystic fibrosis bronchiectasis (NCFB). IPA is well-recognized as a severe fungal lung infection, frequently observed in patients following procedures such as allogeneic bone marrow transplantation and solid organ transplantation, as well as alongside conditions including hematologic malignancies, late-stage HIV infection, and chronic granulomatosis (1-3). The disease has also grown in prevalence as a comorbidity in patients with structural lung diseases such as chronic obstructive pulmonary disease (COPD), interstitial lung disease (ILD), and noncystic fibrosis bronchiectasis (NCFB)-all of which confer different immune dysfunctions to their patients.Due to the significance of immunology in fungal infection, IPA has been an area of focus for many experts. Several studies have described an increase of IPA incidence in COPD patients (3-7); however, IPA assessments in relation to other common respiratory diseases remain scarce, particularly those evaluating patient immune status. Therefore, this study aims to assess the immune status of IPA patients with COPD, ILD, and NCFB while excluding the presence of basic diseases. Methods Study design and diagnostic procedureOur study retrospectively assessed patients treated at Shanghai Pulmonary Hospital, Tongji University, between 2004 and 2013. Diagnosis of IPA was classified as proven, probable, or possible in accordance with the revised EORTC and MSG criteria (8,9). Consequently, a diagnosis of "proven IPA" was established by both (I) the presence of hyphae compatible with Aspergillus in specimens collected from a pulmonary lesion sample; and (II) isolation of Aspergillus species in cultures from any lower respiratory tract (LRT) sample, mainly sputum and bronchial secretions, including bronchial brush and bronchial alveolar lavage fluid, etc. combined with evidence of associated tissue damage or two sequential positive serum galactomannan (GM) tests.COPD diagnosis was established according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria (10). In patients with COPD, Bulpa criteria were used for IPA diagnosis (5). NCFB diagnosed routinely and confirmed through high-resolution computed tomography (HRCT) chest imaging and patient history of the syndrome (11,12). ILD diagnosis was established according to the American Thoracic Society Clinical Practice Gu...

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