Invasive pulmonary aspergillosis in acute exacerbation of chronic obstructive pulmonary disease and the diagnostic value of combined serological tests.
OBJECTIVE
Invasive pulmonary aspergillosis (IPA) among patients with chronic obstructive pulmonary disease (COPD) is increasing in frequency. We conducted this study to find out the approximate incidence of IPA in patients with acute exacerbation of COPD (AECOPD), and to determine whether using a combination of two tests (galactomannan [GM] antigen and 1,3-beta-glucan [BG] detection) would result in a more specific diagnosis of IPA.


METHODS
The study included 261 patients with AECOPD admitted over two years. The patients were categorized according to the modified definitions for IPA. GM antigen and BG were detected by the Platelia Aspergillus and Glucatell tests.


RESULTS
Two patients had proven IPA, three had probable IPA, and two had possible IPA. The rate of proven or probable IPA in patients with AECOPD was 1.91% (5/261). Four patients with proven and probable IPA had been treated with a systemic or inhaled corticosteroid before hospitalization and the typical symptoms and diagnostic signs of IPA were relatively less common in them. Mortality in patients with proven and probable IPA was 80%. The specificity of combined GM and BG detection was 98.8%.


CONCLUSIONS
Combining two serological tests increased the specificity of diagnosis but further trials are needed to prove the value of this approach.
Gao
Xiaofang
X
Department of Respiratory Medicine, Chinese People's Liberation Army General Hospital, Beijing, Chinese People's Liberation Army No. 150 Hospital, Luoyang, China. fangzhai@tom.com
Chen
Liangan
L
Hu
Guangrong
G
Mei
Haiyu
H
D000208:Acute Disease; D000305:Adrenal Cortex Hormones / Q000009:adverse effects / Q000627:therapeutic use; D000368:Aged; D000946:Antigens, Fungal; D005260:Female; D005690:Galactose / Q000031:analogs & derivatives; D006801:Humans; D055744:Invasive Pulmonary Aspergillosis / Q000097:blood* / Q000175:diagnosis / Q000209:etiology / Q000382:microbiology; D008297:Male; D008351:Mannans; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000097:blood / Q000150:complications* / Q000382:microbiology / Q000401:mortality; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012698:Serologic Tests; D047071:beta-Glucans
D000305:Adrenal Cortex Hormones; D000946:Antigens, Fungal; D008351:Mannans; D047071:beta-Glucans; C012990:galactomannan; C033363:beta-1,3-glucan; D005690:Galactose