Significance of Aspergillus fumigatus Isolation from Respiratory Specimens of Nongranulocytopenic Patients

Abstract

The aim of this study was to determine the significance of isolation of Aspergillus fumigatus from cultures of respiratory specimens in nongranulocytopenic patients. The medical records of patients with respiratory specimens positive for Aspergillus fumigatus who were admitted to an adult pneumology ward were reviewed during a 2-year period. A total of 80 respiratory specimens from 76 patients yielded Aspergillus fumigatus. Forty-eight patients were colonized with Aspergillus fumigatus, whereas the 28 (37%) remaining patients had pulmonary aspergillosis, manifest as aspergilloma ( n=19 patients), chronic necrotizing pulmonary aspergillosis ( n=7 patients), and bronchial aspergillosis ( n=2 patients). The presence of typical hyphae in direct examination of bronchoscopic specimens was more likely to be found in infected than in colonized patients ( P=0.04). No immunological test was positive in colonized patients, whereas anti- Aspergillus antibodies were detected in 55% of infected patients ( P<0.001). Pulmonary tuberculosis was the most common underlying lung disease in patients with aspergilloma, but it was not found in any patient with chronic necrotizing pulmonary aspergillosis ( P=0.006). Anti- Aspergillus antibodies were more likely to be detected in patients with aspergilloma (78%) than in patients with chronic necrotizing pulmonary aspergillosis (14%) ( P=0.007). The analysis of predisposing factors, in conjunction with immunological tests and examination of bronchoscopic specimens, is helpful in distinguishing between colonization and infection with Aspergillus fumigatus, as well as for differentiating between aspergilloma and chronic necrotizing pulmonary aspergillosis.

Chronic pulmonary aspergillosis: rationale and clinical guidelines for diagnosis and management

“…Contribution of histology, microscopy, culture and PCR on respiratory samples to the diagnosis of CPA The presence of Aspergillus fumigatus in sputum is not diagnostic because of the ubiquitous nature of the fungus and the different pathologies attributable to the fungus. However, the presence of A. fumigatus in a bronchoscopic specimen is far more common in infection compared to colonisation [29] and is consistent with infection, including CPA. Microscopy of sputum or bronchoscopy specimens often reveals fungi, but has not been systematically studied (SoR A and QoE III) (table 4).…”

“…The presence of anti-Aspergillus antibodies differentiates between infected and colonised patients with a positive predictive value of 100% for detecting infection [29]. Numerous commercial assays are available, in addition to some in-house serology methods, usually Aspergillus precipitins detection by immunodiffusion or counter-immunoelectrophoresis [5,29,42,43,[45][46][47][52][53][54].…”

Evaluation of a Recombinant Antigen-Based Enzyme Immunoassay for the Diagnosis of Noninvasive Aspergillosis

“…Direct examination and culture of bronchopulmonary samples are considered nonoptimal, because of insufficient sensitivity, and of possible misinterpretation due to aerial contamination (16). Since circulating antigens can be detected only in the course of invasive aspergillosis, the detection of anti-Aspergillus antibodies appears thus as a key diagnostic tool for noninvasive forms of aspergillosis.…”

Fungus culture and PCR in nasal lavage samples of patients with chronic rhinosinusitis

“…Fungal infection, mainly by moulds, can impose a severe acute and chronic sinusitis in the immunocompromised host (Malani & Kauffman, 2002). In contrast, fungi are regarded as frequent innocent bystanders when cultured from the respiratory tract of immunocompetent hosts (Uffredi et al, 2003). Allergic fungal rhinosinusitis (AFRS) is an IgE-mediated hypersensitivity reaction to fungal colonization of the paranasal sinus mucosa.…”