The Performance of Real-Time PCR, Galactomannan, and Fungal Culture in the Diagnosis of Invasive Aspergillosis in Ventilated Patients with Chronic Obstructive Pulmonary Disease (COPD)
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Emerging reports have associated chronic pulmonary obstructive disease (COPD) with invasive aspergillosis (IA), particularly in patients treated with mechanical ventilation and/or corticosteroids. This is a multicentre study in which COPD patients demonstrating a new lung infiltrate while being mechanically ventilated were prospectively evaluated for the presence of IA. From the 47 patients studied, Aspergillus fumigatus was recovered in culture in two patients (4.2%). While serum galactomannan (GM) was negative for 94% of patients, GM levels in respiratory samples were >0.5, >1.0 and >1.5 for 74.5, 40.5, and 21.3% of patients, respectively. PCR was positive for 10 patients in the study but did not differentiate Aspergillus colonization from infection. The combination of PCR and GM in respiratory samples may be an interesting alternative to diagnose IA in COPD patients.
KeywordsAspergillosis Aspergillus fumigatus COPD Galactomannan PCR
We are in debt with our ICU and infection control colleagues, for their help in recruiting patients for this study. We thank Prof. Arnaldo Colombo for his thoughts on this subject. This study was sponsored by independent research grants from Pfizer, Biometrix, and Myconostica.
Conflict of interest
Dr Denning holds founder shares in F2G Ltd a University of Manchester spin-out company and has received grant support from F2G as well as the Fungal Research Trust, the Wellcome Trust, the Moulton Trust, The Medical Research Council, The Chronic Granulomatous Disease Research Trust, the National Institute of Allergy and Infectious Diseases, National Institute of Health Research, the European Union, and AstraZeneca. He acts as an advisor/consultant to F2G and Myconostica (now part of Lab21 group) as well as other companies over the last 5 years including Pfizer, Schering Plough (now Merck), Nektar, Astellas, and Gilead. He has been paid for talks on behalf of Merck, Astellas, Novartis, Merck, Dainippon, and Pfizer. In the past 5 years, Dr Pasqualotto has received grant support from Pfizer, Merck, United Medical, Bagó, CAPES, CNPq, FAPERGS, The Fungal Research Trust, Sigma-Tau, and Myconostica. He has been a speaker to or has received travel grants from Pfizer, Schering-Plough (now Merck), Astellas, United Medical, Biometrix, Merck, and Bagó. All other authors have no conflict of interest to declare.
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