The clinical significance of Aspergillus-positive respiratory samples.
COPD
allergic bronchopulmonary aspergillosis
asthma
bronchiectasis
chronic infection
pulmonary aspergillosis
Journal
Mycoses
ISSN: 1439-0507
Titre abrégé: Mycoses
Pays: Germany
ID NLM: 8805008
Informations de publication
Date de publication:
May 2023
May 2023
Historique:
revised:
27
12
2022
received:
20
09
2022
accepted:
07
01
2023
medline:
4
4
2023
pubmed:
20
1
2023
entrez:
19
1
2023
Statut:
ppublish
Résumé
Aspergilli moulds are frequently detected in sputum and other respiratory samples. It is not known what the significance of these findings is, or how to differentiate contamination, temporary or persistent colonisation from clinical infection when Aspergilli are found in respiratory samples. In this study we studied the clinical significance of Aspergillus findings from respiratory samples. We retrospectively evaluated 299 patients who had provided Aspergillus-positive respiratory samples in 2007-2016, which provided a follow-up time of 3-13 years. Data were collected from laboratory registry and Helsinki University Hospital medical records. Underlying diseases, immunosuppression, reasons for sample collection, clinical significance of positive Aspergillus culture, antifungal medication, and patient survival were assessed. Underlying pulmonary disease had 88% of patients, most commonly asthma (44%), bronchiectasis (30%) or COPD (21%). Corticosteroids (orally or inhalation therapy) prior to positive samples used 78%; the use of corticosteroids did not explain the development of Aspergillus disease. Pulmonary disease caused by Aspergillus was identified in 88 (29%) of the reviewed patients; remaining samples did not represent clinical disease. Chronic cavitary or fibrosing pulmonary aspergillosis (CCPA or CFPA) had 44 (49%) of the diseased. The probability of Aspergillus disease increased when Aspergillus-positive samples were given repeatedly within 1 year (p = .001). Mortality for all reasons was 45%. The repeated positive samples did not predict survival (p = .084), but the diagnosis of CPA did (p < .001). The possibility of Aspergillus disease increases when Aspergilli are found repeatedly, collection of samples should be repeated due to method insensitivity. Diagnosis of CPA predicted significantly lower survival.
Sections du résumé
BACKGROUND
BACKGROUND
Aspergilli moulds are frequently detected in sputum and other respiratory samples. It is not known what the significance of these findings is, or how to differentiate contamination, temporary or persistent colonisation from clinical infection when Aspergilli are found in respiratory samples.
OBJECTIVES
OBJECTIVE
In this study we studied the clinical significance of Aspergillus findings from respiratory samples.
METHODS
METHODS
We retrospectively evaluated 299 patients who had provided Aspergillus-positive respiratory samples in 2007-2016, which provided a follow-up time of 3-13 years. Data were collected from laboratory registry and Helsinki University Hospital medical records. Underlying diseases, immunosuppression, reasons for sample collection, clinical significance of positive Aspergillus culture, antifungal medication, and patient survival were assessed.
RESULTS
RESULTS
Underlying pulmonary disease had 88% of patients, most commonly asthma (44%), bronchiectasis (30%) or COPD (21%). Corticosteroids (orally or inhalation therapy) prior to positive samples used 78%; the use of corticosteroids did not explain the development of Aspergillus disease. Pulmonary disease caused by Aspergillus was identified in 88 (29%) of the reviewed patients; remaining samples did not represent clinical disease. Chronic cavitary or fibrosing pulmonary aspergillosis (CCPA or CFPA) had 44 (49%) of the diseased. The probability of Aspergillus disease increased when Aspergillus-positive samples were given repeatedly within 1 year (p = .001). Mortality for all reasons was 45%. The repeated positive samples did not predict survival (p = .084), but the diagnosis of CPA did (p < .001).
CONCLUSIONS
CONCLUSIONS
The possibility of Aspergillus disease increases when Aspergilli are found repeatedly, collection of samples should be repeated due to method insensitivity. Diagnosis of CPA predicted significantly lower survival.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
387-395Subventions
Organisme : Hengityssairauksien Tutkimussäätiö
Organisme : Nummelan parantolan säätiö
Organisme : Suomen Tuberkuloosin Vastustamisyhdistyksen Säätiö
Organisme : Tampereen Tuberkuloosisäätiö
Organisme : Väinö ja Laina Kiven Säätiö
Informations de copyright
© 2023 Wiley-VCH GmbH.
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