Serologic monitoring of disease and treatment in a patient with pulmonary aspergilloma.
Disease progression and efficacy of fungistatic treatment in pulmonary aspergilloma (PA) are difficult to monitor. The usefulness of chest tomography, IgG-ELISA serology, double immunodiffusion, and IgG-immunoblotting was assessed in monitoring disease progression and efficacy of itraconazole treatment during a 9-yr follow-up of a patient with two exacerbations of PA. A rise in IgG-ELISA titer coincided with a recrudescence of clinical symptoms, whereas a decrease after treatment paralleled clinical improvement. IgG-binding to a 32-kD serine protease and to 60- and 94-kD proteins produced with collagen-containing culture medium closely corresponded with IgG-ELISA titers. IgG-binding to a 40-kD metalloprotease remained at very low levels until symptoms and fungal growth became well advanced, when a sharp rise was seen. Responses to all antigens rapidly diminished after the start of successful treatment with itraconazole. Serology may be a useful adjunct in the monitoring of disease progression and the efficacy of itraconazole treatment in patients with PA. IgG-binding to individual fungal proteins shows subtle differences in kinetics. Immunologic responses to fungal proteases raised with collagen-containing culture media may reflect fungal proteolytic involvement during disease progression and treatment more closely than responses to proteins raised with conventional media.
Tomee
J F
JF
Department of Allergology, University Hospital Groningen, The Netherlands.
van der Werf
T S
TS
Latge
J P
JP
Koeter
G H
GH
Dubois
A E
AE
Kauffman
H F
HF
D000328:Adult; D000908:Antibodies, Fungal / Q000097:blood*; D001228:Aspergillosis / Q000175:diagnosis* / Q000188:drug therapy; D001232:Aspergillus fumigatus / Q000276:immunology*; D002908:Chronic Disease; D018450:Disease Progression; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood*; D017964:Itraconazole / Q000627:therapeutic use; D008168:Lung / Q000000981:diagnostic imaging; D008172:Lung Diseases, Fungal / Q000175:diagnosis* / Q000188:drug therapy; D008297:Male; D015166:Monitoring, Immunologic / Q000379:methods; D012008:Recurrence; D014057:Tomography, X-Ray Computed
D000908:Antibodies, Fungal; D007074:Immunoglobulin G; D017964:Itraconazole