Objectives: Pulmonary Aspergillosis is a world-widely distributed disease. The prevalence of Aspergillus infection in patients with delay resolution community acquired pneumonia (DR-CAP) or lower respiratory tract infection (LRTI) had not been investigated in Taiwan. The aims of the study was prospectively evaluate the prevalence of Aspergillus infection by serological testing and microbiological evidence in high risk patients presented with DR-CAP or LRTI.
Methods: Patients presented with LRTI or DR-CAP were prospectively enrolled. Patients with underling chronic pulmonary disease (CLD), active tuberculosis (TB), collagen fiber disorders were study groups, and others who were healthy without underling disorders except DR-CAP or LRTI. Delay resolution of community acquired pneumonia (DR-CAP) was defined as clinical diagnosis with community acquired pneumonia not significantly getting resolution after 3-4 weeks of appropriate anti-bacterial antibiotics. Serum gamma-immunoglobulin (IgG) concentration for Aspergillus niger (A. niger) and Aspergillus fumigatus (A. fumigatus) were measured by ELISA method. Positive results were recorded by the cut-off-value provided by the company ([email protected], ThermoFisher Scientic Inc.). Microbiological evidence for mold infection was record according to the results of fungus culture from sputum, bronchioalveloar lavage fluid (BALF), or nasal/throat swab. Patients were excluded for pulmonary malignancy by diagnostic approach such as bronchoscopic and transthoracic lung biopsy.
Results: From 2018 April to 2019 Jan, a total of 99 patients were enrolled. Overall, 38.3%, 25.1%, and 11.1% of patients were with CLD, collagen fiber disorders, and active TB or old TB with complete anti-TB therapy (ATT), respectively. There were 19% of patients were healthy but presented with LRTI not response to anti-bacterial antibiotics. Overall, seroprevalence for A. niger and A. fumigatus were 32.3% and 22.9%, and the patients with CLD had a highest seroprevalence with 35.4% and 36.6%, respectively. In combination of microbiological and serological results, the prevalence for mold infection was 59%, and CLD remained a highest-risk disorder (48.7%). Overall, concordance between microbiological results for fungus culture and positive serological results for A. niger and A. fumigatus were 69.6% and 60%, respectively.
Conclusion: Both the serological and microbiological evidence for mold or Aspergillus infection in high-risk patients with DR-CAP or LRTI were high in Taiwan. We also firstly reporeted the seroprevalence for Aspergillus spp. around 10% in patients without underling high-risk disorders, that indicate the populational seroprevalence in north Taiwan.
Full conference title:
- TIMM (2019)