The role of Aspergillus Immunoglobulin G level monitoring in chronic pulmonary aspergillosis patients with surgery as treatment option

FS Sudradjat1,3, RR Richardson1,2, DW Denning1,2

Author address: 

1Manchester Academic Health Science Centre, University of Manchester, Manchester, UK 2The National Aspergillosis Centre, Manchester University NHS Foundation Trust , Manchester, UK 3Parasitology Department, Universitas Indonesia, Jakarta, Indonesia

Abstract: 

Purpose: Surgery is one of the treatment options for chronic pulmonary aspergillosis (CPA) especially single aspergilloma, those with recurrent haemoptysis despite bronchial artery embolisation and unilateral azole-resistant disease. This study aims to evaluate the outcomes of surgery and the correlation between Aspergillus Immunoglobulin G (IgG) titre and clinical condition of the patients.

Methods: Retrospective study of patients who underwent surgery for CPA between 2007 and 2017, with Aspergillus IgG antibodies (Thermo Fisher/Phadia) correlated with surgical success and recurrence. 

Results: 29 patients with CPA underwent surgery with most of them showed histopathology evidence of Aspergillus in lung tissue (n=25, 86%). The mean age was 52 years (20-77). The most common presenting symptoms were haemoptysis (n=16, 55%), cough (n=12, 41%) and shortness of breath (n=8, 28%) before surgery. Recurrent haemoptysis (n=16, 55%) was the most common indication for surgery. Assessed 2-5 months after surgery, 13 patients were asymptomatic (45%) and 7 experienced cough (24%). Twenty-two patients (76%) had single aspergilloma, 3 patients (10%) showed chronic cavitary pulmonary aspergillosis (CCPA) while 4 patients (14%) with Aspergillus nodules. Most of the patients had underlying lung disease; tuberculosis (n=5, 17%), bronchiectasis (n=5, 17%), chronic obstructive pulmonary disease (n=5, 17%), asthma (n=4, 14%) and sarcoidosis (n=2, 7%). The procedures included lobectomy (n=23, 79%), wedge resection (n=4, 14%), decortication (n=1, 3%), video-assisted thoracoscopic surgery (n=2, 7%) and myoplasty (n=1, 3%). Main complications were pneumothorax (n=6, 21%) and subcutaneous emphysema (n=3, 10%). The mean Aspergillus IgG level before surgery was 217.3 mg/L and 2-5 months after surgery 163.1mg/L. Recurrence of CPA was noted in 14 patients (48%). In this recurrent group, the mean Aspergillus IgG level when patients relapsed was 340.2 mg/L and decreased to 144.6 mg/L along with the clinical improvement of patients measured 6 months after antifungal therapy. 

Conclusion: Surgery in these selected CPA patients resulted in favourable outcomes with the decrease in clinical symptoms and the Aspergillus IgG level of patients after 2-5 months post-surgery. These findings suggest that in general, Aspergillus IgG test is a potential tool for evaluating therapy and predict recurrences of CPA. Further work is required to establish this.

Keywords: Aspergillosis, surgery, Aspergillus fumigatus, Immunoglobulin G

2018

Full conference title: 

The 8th Advances Against Aspergillus, Lisbon Conference Center, Lisbon, Portugal
    • AAA 8th (2018)