Improving Diagnostic Sensitivity of Chronic Pulmonary Aspergillosis Using Species-Specific IgG.

IF 3.1 2区医学 Q1 DERMATOLOGY

Mycoses Pub Date : 2025-09-01 DOI:10.1111/myc.70107

Inderpaul Singh Sehgal, Ritesh Agarwal, Valliappan Muthu, Sahajal Dhooria, Kuruswamy Thurai Prasad, Shivaprakash M Rudramurthy, Ashutosh Nath Aggarwal, Mandeep Garg, Arunaloke Chakrabarti

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引用次数: 0

Abstract

Background: Chronic pulmonary aspergillosis (CPA) is most commonly caused by Aspergillus fumigatus (AF-CPA). Serum A. fumigatus-IgG, a pivotal investigation for diagnosing CPA, misses 10%-15% of CPA cases. We aimed to determine whether measuring serum IgG against non-fumigatus Aspergillus species enhances the serodiagnosis of CPA.

Methods: We prospectively enrolled consecutive, treatment-naïve adults with CPA. The diagnosis of CPA was made using the ESCMID-ERS criteria. Serum IgG against Aspergillus fumigatus, Aspergillus flavus, Aspergillus niger and Aspergillus terreus (cut-off, 27 mgA/L) was measured by fluorescent enzyme immunoassay. Non-fumigatus-CPA (NF-CPA) was defined when non-fumigatus species-specific IgG titres exceeded A. fumigatus-IgG by ≥ 25%. The primary objective was to evaluate the incremental diagnostic yield of non-fumigatus species-specific IgG for identifying CPA cases missed by A. fumigatus-IgG. The secondary outcome was to compare clinical features and treatment outcomes of AF-CPA and NF-CPA.

Results: Among 279 patients (mean age 45.7 ± 14.8 years, 64% male), seropositivity was 95.3% for A. fumigatus, 70.6% for A. flavus, 56.6% for A. niger and 30.5% for A. terreus. The addition of non-fumigatus-IgG increased serologic yield by 61%. NF-CPA was diagnosed in 14% (39/279), with A. fumigatus-IgG alone missing 25.6% of these cases. Treatment outcomes at six (n = 228) and 12 (n = 222) months were similar between AF-CPA and NF-CPA groups, although the percentage reduction in serum A. fumigatus-IgG was significantly greater in AF-CPA.

Conclusions: Incorporating non-fumigatus Aspergillus-IgG enhances the serodiagnosis of CPA. However, treatment outcomes are similar in patients with AF-CPA and NF-CPA.

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利用种特异性IgG提高慢性肺曲霉病的诊断敏感性。

背景：慢性肺曲霉病（CPA）最常由烟曲霉（afcpa）引起。血清烟状芽胞杆菌igg是诊断CPA的关键指标，漏诊率为10%-15%。我们的目的是确定血清IgG对非烟曲霉种是否能提高CPA的血清诊断。方法：我们前瞻性地招募了连续的treatment-naïve成年CPA患者。采用ESCMID-ERS标准诊断CPA。采用荧光酶免疫法测定血清对烟曲霉、黄曲霉、黑曲霉和地曲霉的IgG（截止值为27 mgA/L）。non-fumigatus - cpa （NF-CPA）定义为非烟曲霉属特异性IgG滴度超过烟曲霉属IgG滴度≥25%。主要目的是评估非烟曲霉种特异性IgG的增量诊断率，以识别烟曲霉属IgG遗漏的CPA病例。次要结果是比较AF-CPA和NF-CPA的临床特征和治疗结果。结果279例患者（平均年龄45.7±14.8岁，男性64%），烟曲霉血清阳性率为95.3%，黄曲霉阳性率为70.6%，黑曲霉阳性率为56.6%，地曲霉阳性率为30.5%。非烟熏igg的加入使血清产量提高了61%。14%（39/279）的病例被诊断为NF-CPA，其中25.6%的病例未诊断为烟熏假杆菌igg。AF-CPA组和NF-CPA组在6个月（n = 228）和12个月（n = 222）时的治疗结果相似，但AF-CPA组血清烟曲霉igg降低的百分比显著高于NF-CPA组。结论：非烟曲霉igg可提高CPA的血清诊断。然而，AF-CPA和NF-CPA患者的治疗结果相似。

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

Mycoses 医学-皮肤病学

CiteScore

10.00

自引率

8.20%

发文量

143

审稿时长

6-12 weeks

期刊介绍： The journal Mycoses provides an international forum for original papers in English on the pathogenesis, diagnosis, therapy, prophylaxis, and epidemiology of fungal infectious diseases in humans as well as on the biology of pathogenic fungi. Medical mycology as part of medical microbiology is advancing rapidly. Effective therapeutic strategies are already available in chemotherapy and are being further developed. Their application requires reliable laboratory diagnostic techniques, which, in turn, result from mycological basic research. Opportunistic mycoses vary greatly in their clinical and pathological symptoms, because the underlying disease of a patient at risk decisively determines their symptomatology and progress. The journal Mycoses is therefore of interest to scientists in fundamental mycological research, mycological laboratory diagnosticians and clinicians interested in fungal infections.