Clinical characteristics and prognosis of chronic pulmonary aspergillosis

• Published in: Respiratory medicine Vol. 106; no. 5; pp. 724 - 729
• Main Authors: Ohba, Hisano, Miwa, Seiichi, Shirai, Masahiro, Kanai, Miho, Eifuku, Tatsuru, Suda, Takafumi, Hayakawa, Hiroshi, Chida, Kingo
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier Ltd 01-05-2012; Elsevier; Elsevier Limited
• Subjects: Aged; Aged, 80 and over; Antibodies, Fungal - blood; Antigens, Fungal - blood; Aspergillus - classification; Aspergillus - immunology; Aspergillus - isolation & purification; Aspergillus fumigatus; Biological and medical sciences; Body Mass Index; Chronic cavitary pulmonary aspergillosis; Chronic Disease; Chronic necrotizing pulmonary aspergillosis; Chronic pulmonary aspergillosis; Female; Human mycoses; Humans; Infectious diseases; Invasive Pulmonary Aspergillosis - diagnosis; Invasive Pulmonary Aspergillosis - microbiology; Kaplan-Meier Estimate; Male; Medical sciences; Middle Aged; Mortality; Multivariate analysis; Mycobacterium; Mycoses; Mycoses of the respiratory system; Nutrition research; Pneumology; Prognosis; Pulmonary Aspergillosis - diagnosis; Pulmonary Aspergillosis - microbiology; Pulmonary/Respiratory; Retrospective Studies; Sensitivity and Specificity; Studies; Tuberculosis; Chronic necrotizing pulmonary aspergillosis; Chronic cavitary pulmonary aspergillosis; Chronic pulmonary aspergillosis; Infection; Lung disease; Chronic; Prognosis; Mycosis; Pulmonary aspergillosis; Respiratory disease; Pneumology
• ISSN: 0954-6111; 1532-3064
• DOI: 10.1016/j.rmed.2012.01.014

Summary Background The details of the clinical characteristics of patients with chronic pulmonary aspergillosis (CPA) have not been fully understood. Method One hundred twenty-nine consecutive patients with isolation of Aspergillus species by culture from respiratory specimens who attended our hospital between October 2001 and September 2009 were enrolled. Patients diagnosed with chronic pulmonary aspergillosis (CPA) were retrospectively reviewed for clinical characteristics and prognosis, compared with patients with Aspergillus species colonization. Results Forty-two (32.6%) were diagnosed with CPA, whereas 87 (67.4%) with colonization. Aspergillus fumigatus was significantly more frequently detected in the CPA group than in the colonization group. Regarding underlying diseases, CPA patients had a significantly higher prevalence of a history of pulmonary tuberculosis and diabetes mellitus than colonization patients. There were no significant differences between the CPA and colonization group in Aspergillus antigen titers. Positivity for Aspergillus precipitating antibody was 74.3% in CPA and 15.8% in colonization, respectively. Sensitivity and specificity of Aspergillus precipitating antibody for the determination of CPA was 74.4% and 84.1%, respectively.Patients with CPA had significantly shorter survival than patients with colonization (mortality rate 50.0% vs. 13.8%, observation periods: 28.7 ± 26.6 months) ( p  < 0.0001). Multivariable analysis revealed that BMI was an independent predictor of prognosis (Odds Ratio, 1.973; p  = 0.0223). Conclusions CPA is a disease with a poor prognosis, which shows distinct clinical characteristics from colonization.