Abstract
Aspergillosis is a mycosis, most commonly affecting the airways. This mycosis can worsen the clinical condition of patients with concurrent lung diseases. We assayed for the presence of serum anti-A. fumigatus IgG in bronchiectasis patients from a tertiary hospital in south Brazil and evaluated the relationship with clinical outcome. Thirty-one patients with bronchiectasis, without cystic fibrosis, were included. Clinical and epidemiological data were collected from all participants. Positive serological tests were detected in 13% (4/31) of the patients. The mortality rate for the year following the assay was, in the seropositive group, 75% (3/4), whereas in the seronegative group, 15% (4/27). An illustrative case is also shown and discussed. Our study highlights the diagnostic challenge and the possible impact of Aspergillus infection on these patients, indicating the necessity of more and larger investigations in the field.
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References
Agarwal R, Chakrabarti A, Shah A, Gupta D, Meis JF, Guleria R et al (2013) Allergic bronchopulmonary aspergillosis: review of literature and proposal of new diagnostic and classification criteria. Clin Exp Allergy 43(8):850–873. https://doi.org/10.1111/cea.12141
Altenburg J, Wortel K, van der Werf TS, Boersma WG (2015) Non-cystic fibrosis bronchiectasis: Clinical presentation, diagnosis and treatment, illustrated by data from a dutch teaching hospital. Neth J Med 73(4):147–154
Barker AF (2002) Bronchiectasis. N Engl J Med 346(18):1383–1393. https://doi.org/10.1056/NEJMra012519
Baxter CG, Denning DW, Jones AM, Todd A, Moore CB, Richardson MD (2013) Performance of two aspergillus IgG EIA assays compared with the precipitin test in chronic and allergic aspergillosis. Clin Microbiol Infect 19(4):197–204. https://doi.org/10.1111/1469-0691.12133
Bongomin F, Asio LG, Baluku JB, Kwizera R, Denning DW (2020) Chronic pulmonary aspergillosis: notes for a clinician in a resource-limited setting where there is no mycologist. J Fungi 6(2):1–19. https://doi.org/10.3390/jof6020075
Boyton RJ (2009) Regulation of immunity in bronchiectasis. Med Mycol 47:175–182. https://doi.org/10.1080/13693780802163370
Chotirmall SH, Martin-Gomez MT (2018) Aspergillus Species in bronchiectasis: challenges in the cystic fibrosis and non-cystic fibrosis airways. Mycopathologia 183(1):45–59. https://doi.org/10.1007/s11046-017-0143-7
Chotirmall SH, Al-Alawi M, Mirkovic B, Lavelle G, Logan PM, Greene CM et al (2013) Aspergillus -associated airway disease, inflammation, and the innate immune response. Biomed Res Int. https://doi.org/10.1155/2013/723129
David DW, Pleuvry A, Cole DC (2013) Global burden of allergic bronchopulmonary aspergillosis with asthma and its complication chronic pulmonary aspergillosis in adults. Med Mycol 51(4):361–370. https://doi.org/10.3109/13693786.2012.738312
De Soyza A, Aliberti S (2017) Bronchiectasis and aspergillus: howare they linked? Med Mycol 55(1):69–81. https://doi.org/10.1093/mmy/myw109
De Valk HA, Meis JFGM, Curfs IM, Muehlethaler K, Mouton JW, Klaassen CHW (2005) Use of a novel panel of nine short tandem repeats for exact and high-resolution fingerprinting of Aspergillus fumigatus isolates. J Clin Microbiol 43(8):4112–4120. https://doi.org/10.1128/JCM.43.8.4112-4120.2005
Denning DW, Pleuvry A, Cole DC (2011) Global burden of chronic pulmonary aspergillosis as a sequel to pulmonary tuberculosis. Bull World Health Organ 89(12):864–872. https://doi.org/10.2471/BLT.11.089441
Denning DW, Cadranel J, Beigelman-Aubry C, Ader F, Chakrabarti A, Blot S et al (2016) Chronic pulmonary aspergillosis: rationale and clinical guidelines for diagnosis and management. Eur Respir J 47(1):45–68. https://doi.org/10.1183/13993003.00583-2015
Denning DW, Page ID, Chakaya J, Jabeen K, Jude CM, Cornet M et al (2018) Case definition of chronic pulmonary aspergillosis in resource-constrained settings. Emerg Infect Dis 24(8):1–13. https://doi.org/10.3201/eid2408.171312
Fang W, Latgé JP (2018) Microbe profile: aspergillus fumigatus: a saprotrophic and opportunistic fungal pathogen. Microbiol (united Kingdom) 164(8):1009–1011. https://doi.org/10.1099/mic.0.000651
Goeminne PC, Nawrot TS, Ruttens D, Seys S, Dupont LJ (2014) Mortality in non-cystic fibrosis bronchiectasis: a prospective cohort analysis. Respir Med 108(2):287–296. https://doi.org/10.1016/j.rmed.2013.12.015
Greenberger PA (2002) Allergic bronchopulmonary aspergillosis. J Allergy Clin Immunol 110(5):685–692. https://doi.org/10.1067/mai.2002.130179
Harada K, Oguma T, Saito A, Fukutomi Y, Tanaka J, Tomomatsu K et al (2018) Concordance between Aspergillus-specific precipitating antibody and IgG in allergic bronchopulmonary aspergillosis. Allergol Int 67:12–17. https://doi.org/10.1016/j.alit.2018.04.009
Hong SB, Go SJ, Shin HD, Frisvad JC, Samson RA (2005) Polyphasic taxonomy of Aspergillus fumigatus and related species. Mycologia 97(6):1316–1329. https://doi.org/10.3852/mycologia.97.6.1316
Kaur S, Singh S (2014) Biofilm formation by Aspergillus fumigatus. Med Mycol 52(1):2–9. https://doi.org/10.3109/13693786.2013.819592
King PT (2009) The pathophysiology of bronchiectasis. Int J Chron Obstruct Pulmon Dis 4:411–419. https://doi.org/10.2147/copd.s6133
King PT, Holdsworth SR, Freezer NJ, Villanueva E, Holmes PW (2007) Microbiologic follow-up study in adult bronchiectasis. Respir Med 101(8):1633–1638. https://doi.org/10.1016/j.rmed.2007.03.009
Kosmidis C, Denning DW (2015) The clinical spectrum of pulmonary aspergillosis. Thorax 70(3):270–277. https://doi.org/10.1136/thoraxjnl-2014-206291
Latgé JP, Chamilos G (2019) Aspergillus fumigatus and Aspergillosis in 2019. Clin Microbiol Rev 33(1):1–75. https://doi.org/10.1128/CMR.00140-18
Máiz L, Nieto R, Cantón R, de la Pedrosa EGG, Martinez-García MÁ (2018) Fungi in bronchiectasis: a concise review. Int J Mol Sci 19(1):1–13. https://doi.org/10.3390/ijms19010142
Marr KA, Patterson T, Denning D (2002) Aspergillosis pathogenesis, clinical manifestations, and therapy. Infect Dis Clin North Am 16(4):875–894. https://doi.org/10.1016/s0891-5520(02)00035-1
Martínez-García MA, Soler-Cataluña JJ, Perpiñá-Tordera M, Román-Sánchez P, Soriano J (2007) Factors associated with lung function decline in adult patients with stable non-cystic fibrosis bronchiectasis. Chest 132(5):1565–1572. https://doi.org/10.1378/chest.07-0490
McDonnell MJ, Jary HR, Perry A, Macfarlane JG, Hester KLM, Small T et al (2015) Non cystic fibrosis bronchiectasis: a longitudinal retrospective observational cohort study of pseudomonas persistence and resistance. Respir Med 109(6):716–726. https://doi.org/10.1016/j.rmed.2014.07.021
Mortensen KL, Johansen HK, Fuursted K, Knudsen JD, Gahrn-Hansen B, Jensen RH et al (2011) A prospective survey of Aspergillus spp in respiratory tract samples: prevalence, clinical impact and antifungal susceptibility. Eur J Clin Microbiol Infect Dis 30(11):1355–1363. https://doi.org/10.1007/s10096-011-1229-7
Page ID, Richardson MD, Denning DW (2016) Comparison of six Aspergillus-specific IgG assays for the diagnosis of chronic pulmonary aspergillosis (CPA). J Infect 72(2):240–249. https://doi.org/10.1016/j.jinf.2015.11.003
Pereira MC, Athanazio RA, de Roth Dalcin PT, de Fernandes Figueiredo MR, Gomes M, de Freitas CG et al (2019) Consenso brasileiro sobre bronquiectasias não fibrocísticas. SciELO. 45(4):1–24. https://doi.org/10.1590/1806-3713/e20190122
Salzer HJF, Cornely OA (2017) Awareness of predictors of mortality may help improve outcome in chronic pulmonary aspergillosis. Eur Respir J 49(2):1602520. https://doi.org/10.1183/13993003.02520-2016
Staab JF, Balajee SA, Marr KA (2009) Aspergillus section fumigati typing by PCR-restriction fragment polymorphism. J Clin Microbiol 47(7):2079–2083. https://doi.org/10.1128/JCM.00551-09
Tiew PY, Thng KX, Chotirmall SH (2022) Clinical aspergillus Signatures in COPD and bronchiectasis. J Fungi 8:480. https://doi.org/10.3390/jof8050480
Ullmann AJ, Aguado JM, Arikan-Akdagli S, Denning DW, Groll AH, Lagrou K et al (2018) Diagnosis and management of Aspergillus diseases: executive summary of the 2017 ESCMID-ECMM-ERS guideline. Clin Microbiol Infect 24:1–38. https://doi.org/10.1016/j.cmi.2018.01.002
Wielpütz MO, Eichinger M, Biederer J, Wege S, Stahl M, Sommerburg O et al (2016) Imaging of cystic fibrosis lung disease and clinical interpretation. RoFo 188(9):834–845. https://doi.org/10.1055/s-0042-104936
Wilopo BAP, Hunter ES, Richardson MD, Denning DW (2020) Optimising the cut-off of the Bordier aspergillus IgG ELISA for the diagnosis of chronic pulmonary aspergillosis. J Microbiol Methods 76:106021. https://doi.org/10.1016/j.mimet.2020.106021
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The authors are grateful to the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior from the Ministry of Education, Brazil (CAPES—BR), under the CAPES-Print Program—Finance Code 001.
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All authors contributed to accomplishment of this manuscript. First draft of the manuscript (MRT, MOX). Care and monitoring of the patients (RPB). Searched the clinical information (RPB, JLB, VRP, KOS). Mycological analyses (JLB, GBK, KOS, VRP, MOX). Molecular analyses (AMM, CVR, RS). Critical review and revision (VRP, DFR, DAS, MOX).
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Trápaga, M.R., Poester, V.R., Sanchotene, K.O. et al. Anti-Aspergillus fumigatus IgG in patients with bronchiectasis and its relationship with clinical outcome. Arch Microbiol 204, 728 (2022). https://doi.org/10.1007/s00203-022-03345-3
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DOI: https://doi.org/10.1007/s00203-022-03345-3