The Performance of Real-Time PCR, Galactomannan, and Fungal Culture in the Diagnosis of Invasive Aspergillosis in Ventilated Patients with Chronic Obstructive Pulmonary Disease (COPD)

• Published in: Mycopathologia (1975) 2012-08, Vol.174 (2), p.163-169
• Main Authors: Aquino, Valério R., Nagel, Fabiano, Andreolla, Huander F., de-Paris, Fernanda, Xavier, Melissa O., Goldani, Luciano Z., Denning, David W., Pasqualotto, Alessandro C.
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Antibiotics; Aspergillosis; Aspergillus fumigatus; Aspergillus fumigatus - growth & development; Aspergillus fumigatus - isolation & purification; Asthma; Biomedical and Life Sciences; Care and treatment; Chronic obstructive pulmonary disease; Cohort Studies; Colonization; Corticoids; Corticosteroids; Diagnosis; Drug dosages; Eukaryotic Microbiology; Female; Health aspects; Humans; Invasive Pulmonary Aspergillosis - complications; Invasive Pulmonary Aspergillosis - diagnosis; Laboratories; Life Sciences; Lung diseases; Lung diseases, Obstructive; Male; Mannans - analysis; Medical Microbiology; Medical research; Medicine, Experimental; Microbial Ecology; Microbiological Techniques - methods; Microbiology; Microscopy; Middle Aged; Mycology - methods; Plant Sciences; Polymerase chain reaction; Prospective Studies; Pulmonary Disease, Chronic Obstructive - complications; Real-Time Polymerase Chain Reaction - methods; Steroids; Ventilation; Ventilators
• ISSN: 0301-486X; 1573-0832
• DOI: 10.1007/s11046-012-9531-1

Emerging reports have associated chronic pulmonary obstructive disease (COPD) with invasive aspergillosis (IA), particularly in patients treated with mechanical ventilation and/or corticosteroids. This is a multicentre study in which COPD patients demonstrating a new lung infiltrate while being mechanically ventilated were prospectively evaluated for the presence of IA. From the 47 patients studied, Aspergillus fumigatus was recovered in culture in two patients (4.2%). While serum galactomannan (GM) was negative for 94% of patients, GM levels in respiratory samples were >0.5, >1.0 and >1.5 for 74.5, 40.5, and 21.3% of patients, respectively. PCR was positive for 10 patients in the study but did not differentiate Aspergillus colonization from infection. The combination of PCR and GM in respiratory samples may be an interesting alternative to diagnose IA in COPD patients.