Significance of Aspergillus fumigatus Isolation from Respiratory Specimens of Nongranulocytopenic Patients

Article

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.

References

  1. 1.
    Sharma OP, Chwogule R (1998) Many faces of pulmonary aspergillosis. Eur Respir J 12:705–715CrossRefPubMedGoogle Scholar
  2. 2.
    Denning DW (1998) Invasive aspergillosis. Clin Infect Dis 26:781–805PubMedGoogle Scholar
  3. 3.
    Latgé JP (1999) Aspergillus fumigatus and aspergillosis. Clin Microbiol Rev 12:310–350PubMedGoogle Scholar
  4. 4.
    Saraceno JL, Phelps DT, Ferro TJ, Futerfas R, Schwartz DB (1997) Chronic necrotizing pulmonary aspergillosis: approach to management. Chest 112:541–548PubMedGoogle Scholar
  5. 5.
    Caras WE, Pluss JL (1996) Chronic necrotizing pulmonary aspergillosis: pathologic outcome after itraconazole therapy. Mayo Clin Proc 71:25–30PubMedGoogle Scholar
  6. 6.
    Horvarth JA, Dummer S (1996) The use of respiratory-tract cultures in the diagnosis of invasive pulmonary aspergillosis. Am J Med 100:171–178PubMedGoogle Scholar
  7. 7.
    Levy H, Horak DA, Tegtmeier BR, Yokota SB, Forman SJ (1992) The value of bronchoalveolar lavage and bronchial washings in the diagnosis of invasive pulmonary aspergillosis. Respir Med 86:243–248PubMedGoogle Scholar
  8. 8.
    Yu VL, Muder RR, Poorsattar A (1986) Significance of isolation of Aspergillus from the respiratory tract in diagnosis of invasive pulmonary aspergillosis. Am J Med 81:249–254PubMedGoogle Scholar
  9. 9.
    Nalesnik MA, Myerowitz RL, Jenkins R, Lenkey J, Herbert D (1980) Significance of Aspergillus species isolated from respiratory secretions in the diagnosis of invasive pulmonary aspergillosis. J Clin Microbiol 11:370–376PubMedGoogle Scholar
  10. 10.
    American Thoracic Society (1997) Diagnosis and treatment of disease caused by nontuberculous mycobacteria. Am J Resp Crit Care Med 156 [Suppl]:1–25Google Scholar
  11. 11.
    Broderick LS, Conces DJ Jr, Tarver RD, Bergmann CA, Bisesi MA (1996) Pulmonary aspergillosis: a spectrum of disease. Crit Rev Diagn Imaging 37:491–531PubMedGoogle Scholar
  12. 12.
    Gefter WB, Weingrad TR, Epstein DM, Ochs RH, Miller WT (1981) "Semi-invasive" pulmonary aspergillosis: a new look at the spectrum of Aspergillus infections of the lung. Radiology 140:313–321PubMedGoogle Scholar
  13. 13.
    Binder RE, Faling LJ, Pugatch RD, Mahasaen C, Snider GL (1982) Chronic necrotizing pulmonary aspergillosis: a discrete clinical entity. Medicine 61:109–124Google Scholar
  14. 14.
    Denning DW (1995) Commentary: unusual manifestations of aspergillosis. Thorax 50:812–813PubMedGoogle Scholar
  15. 15.
    Treger TR, Visscher DW, Bartlett MS, Smith JW (1985) Diagnosis of pulmonary infection caused by Aspergillus: usefulness of respiratory cultures. J Infect Dis 152:572–576PubMedGoogle Scholar
  16. 16.
    Bodey PG, Vartivarian S (1989) Aspergillosis. Eur J Clin Microbiol Infect Dis 8:413–437PubMedGoogle Scholar
  17. 17.
    Perfect JR, Cox YL, Lee JY, Kauffman CA, Repentigny L de, Chapman SW, Morrison VA, Pappas P, Hiemenz JW, Stevens DA (2001) The impact of culture isolation of Aspergillus species: a hospital-based survey of aspergillosis. Clin Infect Dis 33:1824–1833CrossRefPubMedGoogle Scholar
  18. 18.
    Thompson BH, Stanford W, Galvin JR, Kurihara Y (1995) Varied radiologic appearances of pulmonary aspergillosis. Radiographics 15:1273–1284PubMedGoogle Scholar
  19. 19.
    Miller WT (1996) Aspergillosis: a disease with many faces. Semin Roentgenol 31:52–66PubMedGoogle Scholar
  20. 20.
    Yousem SA (1997) The histological spectrum of chronic necrotizing forms of pulmonary aspergillosis. Hum Pathol 28:650–656PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2003

Authors and Affiliations

  • M. L. Uffredi
    • 1
  • G. Mangiapan
    • 1
  • J. Cadranel
    • 1
  • G. Kac
    • 2
  1. 1.Service de PneumologieHôpital TenonParisFrance
  2. 2.Hygiène HospitalièreHôpital Européen Georges PompidouParis Cedex 15France

Personalised recommendations