title: Characterization of patients with chronic pulmonary aspergillosis according to the new ESCMID/ERS/ECMM and IDSA guidelines.
abstract: Recently, the Infectious Diseases Society of America (IDSA) and the European Society for Clinical Microbiology and Infectious Diseases (ESCMID) in cooperation with the European Respiratory Society (ERS) and the European Confederation of Medical Mycology (ECMM) published guidelines for the diagnosis of chronic pulmonary aspergillosis (CPA). Both guidelines, however, carry significant differences. We retrospectively applied the diagnostic recommendations on a patient cohort of 71 previously diagnosed CPA patients in order to compare both guidelines. In 50 patients (70%) the diagnosis was confirmed by the diagnostic criteria of both guidelines, while nine patients (13%) fulfilled neither the ESCMID/ERS/ECMM nor the IDSA criteria. Reasons were lack of mycological evidence in respiratory samples. These patients were not tested for the presence of Aspergillus-specific IgG antibodies, which is strongly recommended by both guidelines. Seven patients did not fulfil the diagnostic criteria of the IDSA guideline, because of severe immunosuppression, while five patients didn't fulfil the diagnostic criteria of the ESCMID/ERS/ECMM guideline, because of uncommon image findings. The comparison of both guidelines highlight that the combination of a chest CT scan with the performance of an Aspergillus-specific IgG antibody assay are key diagnostic features to establish a guideline-based diagnosis of CPA.
authors.affiliation: Division of Clinical Infectious Diseases, Medical Clinic Research Center Borstel, Borstel, Germany.|German Center for Infection Research, Clinical Tuberculosis Center, Borstel, Germany.
authors.forename: Helmut J F
authors.identifier: http://orcid.org/0000-0003-0146-8310
authors.initials: HJ
authors.lastname: Salzer
authors.affiliation: Division of Clinical Infectious Diseases, Medical Clinic Research Center Borstel, Borstel, Germany.|German Center for Infection Research, Clinical Tuberculosis Center, Borstel, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Heyckendorf
authors.affiliation: Division of Clinical Infectious Diseases, Medical Clinic Research Center Borstel, Borstel, Germany.|German Center for Infection Research, Clinical Tuberculosis Center, Borstel, Germany.
authors.forename: Barbara
authors.initials: B
authors.lastname: Kalsdorf
authors.affiliation: Section of Infectious Diseases and Tropical Medicine, 1st Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.|Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.
authors.forename: Thierry
authors.initials: T
authors.lastname: Rolling
authors.affiliation: Division of Clinical Infectious Diseases, Medical Clinic Research Center Borstel, Borstel, Germany.|German Center for Infection Research, Clinical Tuberculosis Center, Borstel, Germany.|Department of Internal Medicine, University of Namibia School of Medicine, Windhoek, Namibia.|International Health/Infectious Diseases, University of Lübeck, Lübeck, Germany.|Department of Medicine, Karolinska Institute, Stockholm, Sweden.
authors.forename: Christoph
authors.initials: C
authors.lastname: Lange
mesh_terms: D000368:Aged; D000908:Antibodies, Fungal / Q000097:blood; D001230:Aspergillus / Q000276:immunology / Q000302:isolation & purification; D002908:Chronic Disease; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D007074:Immunoglobulin G / Q000097:blood; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic / Q000592:standards*; D055732:Pulmonary Aspergillosis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000382:microbiology; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
chemical_list: D000908:Antibodies, Fungal; D007074:Immunoglobulin G
keywords: 
  CPA
  ; Aspergillus spp; ESCMID/ERS/ECMM guideline; IDSA guideline; chronic pulmonary aspergillosis; diagnostic criteria