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Paracoccidioidomycosis (PCM) is a systemic fungal infection caused by thermally dimorphic fungi of two main species: Paracoccidioides brasiliensis (P. brasiliensis) and Paracoccidioides lutzii (P. lutzii). 1 The distribution of PCM includes subtropical regions and endemic countries with mild temperature and high and constant humidity. 2,3 It is considered the most important deep mycosis in Latin America, 4,5 especially in Brazil, responsible for the majority of reported cases. 3,6

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Chronic pulmonary aspergillosis (CPA) is divided into five subtypes. The diagnosis of CPA is complicated due to poor sensitivity of the laboratory tests. Diagnostic performance of different antigen, serological, and microbiological methods in subtypes of CPA is unknown. The purpose of this study was to evaluate the diagnostic performance in different subtypes of CPA. A total of 91 participants with CPA were included, and the study was performed at Hospital das Clínicas of University of São Paulo. Bronchoalveolar lavage galactomannan (73%, 11/15), serology by immunodiffusion test (81%, 61/75), and histology (78%, 39/50) had the best sensitivity. The counterimmunoelectrophoresis (CIE) titers had a significant statistical difference between the CPA subtypes (P < 0.001), in which the forms chronic fibrosing pulmonary aspergillosis (CFPA) and subacute invasive aspergillosis (SAIA) had higher titers: 1/64 (interquartile range [IQR]: 1/32–1/256) and 1/64 (1/32–1/128). C-reactive protein generally presented lower values (median 15 mg/L, IQR: 6–33), with higher values in SAIA and lower values for Aspergillus nodule. Overall, we found a low diagnostic sensitivity of current tests. Regarding the CPA subtypes, we did not find great differences in the performance of the tests, but it is observed that the inflammatory markers and CIE titers tend to be higher in forms of the more extensive lung parenchyma involvement, such as SAIA and CFPA.

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