Background. Exposure to Aspergillus spp can cause from an invasive infection in immunocompromised hosts to an allergic lung disease in an immunocompetent patient. Sensitization or colonization to this fungus is associated with impairment of the pulmonary function.
Objective. To describe the prevalence of Aspergillus spp. and the clinical, microbiological and immunological features in patients with chronic pulmonary disease (COPD).
Methods. Patients with COPD visiting the Pneumology Unit of four hospitals in Bogotá - Colombia were recruited. All patients who met the selection criteria, were given clinically examined by the investigator of the institution to complete the information of the study and fill in the COPD Assessment Test (CAT™). Socio-demographic, clinical, radiological and laboratory data were recorded. Total leukocyte count, percentage of eosinophils, total IgE (T-IgE) and A. fumigatus specific IgE and IgG levels were reported. Sputum samples were obtained and were examined for bacterial and fungal growth. Results. One hundred twenty-seven patients with COPD (64 females and 63 males) with a mean age of 74 (65-83) years were included. According to classification of the disease stages for the COPD patients, 65 (51.2%) belonged to GOLD stage III and IV, 45 (35.4%) had major dyspnea (mMRC > 2), 111 (87.4%) had a CAT equal or higher than 10 and 32 (25.2%) had frequent exacerbations.Twenty-one (16.5%) and 47 (37.0%) patients presented eosinophilia and bronchiectasis respectively. Aspergillus spp was isolated in 11.8% of COPD patients and 6.9 % had Penicillium species. Candida albicans was isolated in 51 (40.2%). Aspergillus spp. co-culture was not found while Candida spp and pathogenic bacteria co-culture was found in 10.2% of patients. The prevalence of increased serum T-IgE level was 10.2% and 3.9% (cut-off level of 114 kIU/L and 600 kIU/L, respectively). A. fumigatus hypersensitivity and A. fumigatus colonization were confirmed in 7.9%. Patients with A. fumigatus were on a higher ongoing use of inhaled corticosteroids compared to those who were culture-negative (45.5 %vs 93.3%, p=0.0005). There was no difference in other clinical, laboratory and radiological variables studied (lung function, assessment of symptoms, frequency of exacerbations, eosinophilia, total and specific IgE, specific IgG) in COPD patients who were Aspergillus spp. culture-positive compared to those with Aspergillus spp culture-negative.
Conclusions. Findings from this study reveal that COPD patients presented not only Aspergillus colonization also Aspergillus hypersensitivity. However, at that moment it was not possible to correlate these findings with a clinical impact in the lung.
Full conference title:
- ATS 2018