Pulmonary Aspergillosis: Epidemiology and unresolved diagnostic challenges - insights from a two-year retrospective cohort study in Marseille

IF 3.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine Pub Date : 2025-06-10 DOI:10.1016/j.rmed.2025.108206

Thi Quynh Pham , Léa Delorme , Sébastien Cortaredona , Stéphane Ranque , Estelle Menu

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引用次数: 0

Abstract

Objective

Aspergillus spp. are ubiquitous fungi that cause invasive pulmonary aspergillosis (IPA), chronic pulmonary aspergillosis (CPA), allergic bronchopulmonary aspergillosis (ABPA), and some other less common forms depending on the immune status of the host. This study aimed to evaluate the epidemiology and clinical diagnosis of Aspergillus-related diseases at the University Hospital of Marseille (AP-HM).

Methods

We performed a retrospective cohort study of patients treated at the AP-HM between January 2022 and December 2023. Aspergillus-specific serologic tests (IgG, IgE) and galactomannan antigen (GM) tests were integrated with clinical, imaging data from patients’ medical records. Diagnostic frameworks were established based on the standard diagnostic criteria to identify IPA, CPA, and ABPA.

Results

Of 2412 patients with GM testing, 46 (1.9 %) had IPA. Of 2889 patients with Aspergillus-specific IgG testing, 16 (0.6 %) were diagnosed with CPA. Of 1779 patients with Aspergillus-specific IgE testing, 46 (2.6 %) were diagnosed with ABPA. We noted biotherapy (tocilizumab and oblinutuzumab) as potential emerging risk factors for IPA. Strikingly, only 10 of 46 patients with ABPA were treated by physicians, highlighting potential gaps in clinical practice and current diagnostic guidelines. The 3-month case fatality rate was 46.7 % for IPA, 13.3 % for CPA and 0 for APBA. Despite treatment, 13 % of patients with ABPA experienced an exacerbation.

Conclusions

This study highlights the prevalence of Aspergillus-related lung disease and the high 3-month mortality rate in IPA and CPA in AP-HM. Discrepancies in ABPA diagnosis highlight the need for improved diagnostic algorithms that better reflect real-world clinical practice and address these challenges.

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肺曲霉病：流行病学和未解决的诊断挑战-来自马赛两年回顾性队列研究的见解

目的曲霉属真菌是一种普遍存在的真菌，可引起侵袭性肺曲霉病（IPA）、慢性肺曲霉病（CPA）、变应性支气管肺曲霉病（ABPA）以及其他一些不常见的形式，这取决于宿主的免疫状态。本研究旨在评估马赛大学医院曲霉相关疾病的流行病学和临床诊断。方法：我们对2022年1月至2023年12月期间在AP-HM治疗的患者进行了回顾性队列研究。曲霉特异性血清学检测（IgG、IgE）和半乳甘露聚糖抗原（GM）检测与患者医疗记录的临床和影像学数据相结合。根据标准诊断标准建立诊断框架，以确定IPA， CPA和ABPA。结果2412例GM检测患者中，46例（1.9%）有IPA。在2889例曲霉特异性IgG检测患者中，16例（0.6%）被诊断为CPA。在1779例曲霉特异性IgE检测患者中，46例（2.6%）被诊断为ABPA。我们注意到生物疗法（tocilizumab和oblinutuzumab）是IPA的潜在新危险因素。引人注目的是，46名ABPA患者中只有10名接受了医生的治疗，这凸显了临床实践和当前诊断指南的潜在差距。IPA 3个月病死率为46.7%，CPA为13.3%，APBA为0。尽管接受了治疗，13%的ABPA患者病情加重。结论本研究强调了曲霉相关肺部疾病的患病率以及AP-HM中IPA和CPA的3个月死亡率高。ABPA诊断的差异突出了改进诊断算法的必要性，以更好地反映现实世界的临床实践并解决这些挑战。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Respiratory medicine 医学-呼吸系统

CiteScore

7.50

自引率

0.00%

发文量

199

审稿时长

38 days

期刊介绍： Respiratory Medicine is an internationally-renowned journal devoted to the rapid publication of clinically-relevant respiratory medicine research. It combines cutting-edge original research with state-of-the-art reviews dealing with all aspects of respiratory diseases and therapeutic interventions. Topics include adult and paediatric medicine, epidemiology, immunology and cell biology, physiology, occupational disorders, and the role of allergens and pollutants. Respiratory Medicine is increasingly the journal of choice for publication of phased trial work, commenting on effectiveness, dosage and methods of action.