Skip to main content

Advertisement

SpringerLink
Log in

Detection of serum Aspergillus-specific IgM and IgG antibody levels for the diagnosis of chronic pulmonary aspergillosis developed in patients with tuberculosis

  • Original Article
  • Published:
European Journal of Clinical Microbiology & Infectious Diseases Aims and scope Submit manuscript

Abstract

Chronic pulmonary aspergillosis (CPA) is common among individuals with underlying lung diseases. The clinical manifestations of CPA include systemic symptoms (e.g., weight loss, fatigue, fever), chronic productive cough, chest discomfort, and occasional haemoptysis, which are similar to the manifestations of pulmonary tuberculosis (PTB) and are often misdiagnosed as PTB. Considering the striking similarities between CPA and PTB in clinical manifestations and imaging features, more specific microbiological and serological detections are needed for a definitive diagnosis. This study aimed to explore the clinical characteristics of CPA in TB as well as the diagnostic significance of Aspergillus-specific IgG and Aspergillus-specific IgM.

A total of 140 patients diagnosed with TB by culture between December 2017 and February 2019 were included. Enrolled patients were categorized into two groups (CPA group and non-CPA group) according to CPA diagnostic criteria. All collected specimens were subjected to Aspergillus-specific IgG and IgM detection testing.

The median concentration of Aspergillus-specific IgG in the CPA group (211.04 AU/ml) was significantly higher than that in the non-CPA group (77.88 AU/ml) (Z value − 6.397, P < 0.001). The sensitivity and specificity of Aspergillus-specific IgG for CPA diagnosis were 81.82% and 72.97%, respectively. In the chronic cavitary pulmonary aspergillosis (CCPA) group, the IgG positivity rate (≥ 120 AU/ml) was 96.2%, which was 21.4% in the non-CCPA patients (P < 0.001).

The detection of Aspergillus-specific IgG serological changes is feasible and facilitates reliable differentiation between Aspergillus and Mycobacterium tuberculosis infection. However, Aspergillus-specific IgM has limited diagnostic value, with unsatisfactory sensitivity results.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Code availability

Not applicable.

References

  1. Khan R, Malik NI, Razaque A (2020) Imaging of pulmonary post-tuberculosis sequelae. Pak J Med Sci 36(1):S75–S82. https://doi.org/10.12669/pjms.36.ICON-Suppl.1722

    Article  PubMed  PubMed Central  Google Scholar 

  2. van Kampen SC, Wanner A, Edwards M, Harries AD, Kirenga BJ, Chakaya J et al (2018) International research and guidelines on post-tuberculosis chronic lung disorders: a systematic scoping review. BMJ Glob Health 3(4):e000745. https://doi.org/10.1136/bmjgh-2018-000745

    Article  PubMed  PubMed Central  Google Scholar 

  3. World Health Organization (2020) Global Tuberculosis Report 2020. World Health Organization, Geneva, Switzerland (https://www.who.int/publications/i/item/9789240013131)

    Google Scholar 

  4. Allwood BW, van der Zalm MM, Amaral AFS, Byrne A, Datta S, Egere U et al (2020) Post-tuberculosis lung health: perspectives from the First International Symposium. Int J Tuberc Lung Dis 24(8):820–828. https://doi.org/10.5588/ijtld.20.0067

    Article  CAS  PubMed  Google Scholar 

  5. Quaife M, Houben RMGJ, Allwood B, Cohen T, Coussens AK, Harries AD et al (2020) Post-tuberculosis mortality and morbidity: valuing the hidden epidemic. Lancet Respir Med 8(4):332–333. https://doi.org/10.1016/S2213-2600(20)30039-4

    Article  PubMed  Google Scholar 

  6. Lin SY, Chien JY, Chiang HT, Lu MC, Ko WC, Chen YH et al (2021) Ambulatory independence is associated with higher incidence of latent tuberculosis infection in long-term care facilities in Taiwan. J Microbiol Immunol Infect 54(2):319–326. https://doi.org/10.1016/j.jmii.2019.07.008

    Article  CAS  PubMed  Google Scholar 

  7. Barac A, Kosmidis C, Alastruey-Izquierdo A, Salzer HJF (2019) Chronic pulmonary aspergillosis update: A year in review. Med Mycol 57(Supplement_2):S104–S109. https://doi.org/10.1093/mmy/myy070

    Article  CAS  PubMed  Google Scholar 

  8. Patterson TF, Thompson GR 3rd, Denning DW, Fishman JA, Hadley S, Herbrecht R et al (2016) Practice guidelines for the diagnosis and management of aspergillosis: 2016 Update by the Infectious Diseases Society of America. Clin Infect Dis 63(4):e1–e60. https://doi.org/10.1093/cid/ciw326

    Article  PubMed  PubMed Central  Google Scholar 

  9. Oladele RO, Irurhe NK, Foden P, Akanmu AS, Gbaja-Biamila T, Nwosu A et al (2017) Chronic pulmonary aspergillosis as a cause of smear-negative TB and/or TB treatment failure in Nigerians. Int J Tuberc Lung Dis 21(9):1056–1061. https://doi.org/10.5588/ijtld.17.0060

    Article  CAS  PubMed  Google Scholar 

  10. Hosseini M, Shakerimoghaddam A, Ghazalibina M, Khaledi A (2020) Aspergillus coinfection among patients with pulmonary tuberculosis in Asia and Africa countries; A systematic review and meta-analysis of cross-sectional studies. Microb Pathog 141:104018. https://doi.org/10.1016/j.micpath.2020.104018

    Article  CAS  PubMed  Google Scholar 

  11. 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

    Article  PubMed  PubMed Central  Google Scholar 

  12. Yao Y, Zhou H, Shen Y, Yang Q, Ye J, Fu Y et al (2018) Evaluation of a quantitative serum Aspergillus fumigatus-specific IgM assay for diagnosis of chronic pulmonary aspergillosis. Clin Respir J 12(11):2566–2572. https://doi.org/10.1111/crj.12957

    Article  CAS  PubMed  Google Scholar 

  13. Li H, Rui Y, Zhou W, Liu L, He B, Shi Y et al (2019) Role of the Aspergillus-specific IgG and IgM test in the diagnosis and follow-up of chronic pulmonary aspergillosis. Front Microbiol 10:1438. https://doi.org/10.3389/fmicb.2019.01438

    Article  PubMed  PubMed Central  Google Scholar 

  14. Ma X, Wang K, Zhao X, Liu Y, Li Y, Yu X et al (2019) Prospective study of the serum Aspergillus-specific IgG, IgA and IgM assays for chronic pulmonary aspergillosis diagnosis. BMC Infect Dis 19(1):694. https://doi.org/10.1186/s12879-019-4303-x

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Denning DW, Cadranel J, Beigelman-Aubry C, Ader F, Chakrabarti A, Blot S et al (2016) European Society for Clinical Microbiology and Infectious Diseases and European Respiratory Society. 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

    Article  CAS  PubMed  Google Scholar 

  16. Page ID, Byanyima R, Hosmane S, Onyachi N, Opira C, Richardson M et al (2019) Chronic pulmonary aspergillosis commonly complicates treated pulmonary tuberculosis with residual cavitation. Eur Respir J 53(3):1801184. https://doi.org/10.1183/13993003.01184-2018

    Article  PubMed  PubMed Central  Google Scholar 

  17. Denning DW, Riniotis K, Dobrashian R, Sambatakou H (2003) Chronic cavitary and fibrosing pulmonary and pleural aspergillosis: case series, proposed nomenclature change, and review. Clin Infect Dis 37(Suppl 3):S265–S280. https://doi.org/10.1086/376526

    Article  PubMed  Google Scholar 

  18. Smith NL, Denning DW (2011) Underlying conditions in chronic pulmonary aspergillosis including simple aspergilloma. Eur Respir 37(4):865–872. https://doi.org/10.1183/09031936.00054810

    Article  CAS  Google Scholar 

  19. Hedayati MT, Azimi Y, Droudinia A, Mousavi B, Khalilian A, Hedayati N et al (2015) Prevalence of chronic pulmonary aspergillosis in patients with tuberculosis from Iran. Eur J Clin Microbiol Infect Dis 34(9):1759–1765. https://doi.org/10.1007/s10096-015-2409-7

    Article  CAS  PubMed  Google Scholar 

  20. Walsh TJ, Anaissie EJ, Denning DW, Herbrecht R, Kontoyiannis DP, Marr KA et al (2008) Infectious Diseases Society of America. Treatment of aspergillosis: clinical practice guidelines of the Infectious Diseases Society of America. Clin Infect Dis 46(3):327–60. https://doi.org/10.1086/525258

    Article  CAS  PubMed  Google Scholar 

  21. Kohno S, Izumikawa K, Ogawa K, Kurashima A, Okimoto N, Amitani R et al (2010) Japan Chronic Pulmonary Aspergillosis Study Group (JCPASG). Intravenous micafungin versus voriconazole for chronic pulmonary aspergillosis: a multicenter trial in Japan. J Infect 61(5):410–8. https://doi.org/10.1016/j.jinf.2010.08.005

    Article  PubMed  Google Scholar 

  22. Camara B, Reymond E, Saint-Raymond C, Roth H, Brenier-Pinchart MP, Pinel C et al (2015) Grenoble Aspergillus Committee. Characteristics and outcomes of chronic pulmonary aspergillosis: a retrospective analysis of a tertiary hospital registry. Clin Respir J 9(1):65–73. https://doi.org/10.1111/crj.12105

    Article  PubMed  Google Scholar 

  23. 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(Suppl 1):e1–e38. https://doi.org/10.1016/j.cmi.2018.01.002

    Article  PubMed  Google Scholar 

  24. Guo Y, Bai Y, Yang C, Gu L (2019) Evaluation of Aspergillus IgG, IgM antibody for diagnosing in chronic pulmonary aspergillosis: A prospective study from a single center in China. Medicine (Baltimore) 98(16):e15021. https://doi.org/10.1097/MD.0000000000015021

    Article  PubMed  Google Scholar 

  25. Al-Shair K, Atherton GT, Harris C, Ratcliffe L, Newton PJ, Denning DW (2013) Long-term antifungal treatment improves health status in patients with chronic pulmonary aspergillosis: a longitudinal analysis. Clin Infect Dis 57(6):828–835. https://doi.org/10.1093/cid/cit411

    Article  PubMed  PubMed Central  Google Scholar 

  26. Yao Y, Zhou H, Yang Q, Lu G, Yu Y, Shen Y et al (2018) Serum Aspergillus fumigatus-specific IgG antibody decreases after antifungal treatment in chronic pulmonary aspergillosis patients. Clin Respir J 12(4):1772–1774. https://doi.org/10.1111/crj.12702

    Article  CAS  PubMed  Google Scholar 

  27. 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

    Article  PubMed  Google Scholar 

  28. Bozza S, Clavaud C, Giovannini G, Fontaine T, Beauvais A, Sarfati J et al (2009) Immune sensing of Aspergillus fumigatus proteins, glycolipids, and polysaccharides and the impact on Th immunity and vaccination. J Immunol 183(4):2407–2414. https://doi.org/10.4049/jimmunol.0900961

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

We would like to thank Qionglan Zhang of the electronic bronchoscopy room for assistance and Director Lixia Zhang of the Clinical Laboratory of Tianjin Haihe Hospital for guidance. We would like to thank Dynamiker Biotechnology (Tianjin) Co., Ltd., for providing the kits at no cost for this study.

Funding

This study was supported by grants from the Science and Technology Fund of Tianjin Haihe Hospital (HHYY-202013) and the Science and Technology Project of Tianjin Municipal Health Commission (No. 2013KZ043).

Author information

Author notes

  1. Zao-Xian Mei & Hong-Wei Yu

    Present address: Department of Respiratory Medicine, Tianjin Hospital, Tianjin University, Tianjin, China

  2. Zao-Xian Mei and Jun-Feng Han contributed equally to this work, and they are the primary coauthors.

Authors and Affiliations

  1. Department of Tuberculosis, Haihe Hospital, Tianjin University, Tianjin Institute of Respiratory Diseases, Tianjin, China

    Zao-Xian Mei, Jun-Feng Han, Hong-Wei Yu, Ping Ji & Yi Xie

  2. Dynamiker Sub-Center of Beijing Key Laboratory for Mechanisms Research and Precision Diagnosis of Invasive Fungal Disease, Tianjin, 300467, China

    Yuan Zhang

  3. Tianjin Enterprise Key Laboratory for Precision Diagnosis Technology of Invasive Fungal Diseases, Tianjin, 300467, China

    Yuan Zhang

  4. Departments of Laboratory Medicine and Internal Medicine, China Medical University Hospital, College of Medicine, China Medical University, Taichung, Taiwan

    Po-Ren Hsueh

  5. School of Medicine, China Medical University, Taichung, Taiwan

    Po-Ren Hsueh

  6. Departments of Laboratory Medicine and Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan

    Po-Ren Hsueh

Authors
  1. Zao-Xian Mei
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jun-Feng Han
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hong-Wei Yu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yuan Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ping Ji
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yi Xie
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Po-Ren Hsueh
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

ZXM, JFH, HWY, YZ, PJ, and YX conducted the study design. ZXM and JFH tested the specimens. ZXM, JFH, and HWY performed the data analysis and prepared the manuscript. ZXM, JFH, HWY, YZ, PJ, YX, and PRH reviewed and approved the manuscript.

Corresponding authors

Correspondence to Yi Xie or Po-Ren Hsueh.

Ethics declarations

Ethics approval

The study was approved by the Institutional Ethics Committee of Tianjin Haihe Hospital, Tianjin, China (2021HHWZ-001). The institutional review board of the Tianjin Haihe Hospital waived the need for written informed consent because the study involved only a minimal risk to the patients.

Consent to participate

The institutional review board of the Tianjin Haihe Hospital waived the need for written informed consent because the study involved only a minimal risk to the patients.

Conflicts of interest

The authors declare no competing interests.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mei, ZX., Han, JF., Yu, HW. et al. Detection of serum Aspergillus-specific IgM and IgG antibody levels for the diagnosis of chronic pulmonary aspergillosis developed in patients with tuberculosis. Eur J Clin Microbiol Infect Dis 42, 1081–1089 (2023). https://doi.org/10.1007/s10096-023-04637-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10096-023-04637-2

Keywords

Search

Navigation