Diagnosing pulmonary aspergillosis is much easier than it used to be: a new diagnostic landscape
Diagnosing pulmonary aspergillosis is much easier than it used to be: a new diagnostic landscape
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DOI：
10.5588/ijtld.21.0053
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发表时间：
2021-07-01
影响因子：
4
通讯作者：
Denning, D. W.
中科院分区：
文献类型：
--
作者：
Denning, D. W.
过去十年的重大创新使过敏性、慢性和侵袭性肺曲霉病以及支气管炎和曲霉菌结节的诊断更加灵敏和快速。这一新的诊断景观揭示了曲霉病的发病率和患病率大大高于以前的理解，并在此审查总结。口服和静脉内抗真菌治疗为受影响的患者提供了良好的临床反应率。尽管如此，漏诊意味着患者过度使用抗菌剂、皮质类固醇和抗结核药物，导致疾病持续，往往导致死亡。几种高性能诊断测试的临床引入有助于重新定义患者管理。众所周知，在侵袭性和慢性曲霉病患者的支气管镜检查样本中，曲霉抗原可在不到1小时内检测到70-95%。曲霉免疫球蛋白G（IgG）（沉淀素）对慢性和过敏性曲霉病的敏感性>90%，特异性>85%。高容量呼吸道真菌培养和曲霉菌聚合酶链反应的灵敏度比常规细菌培养高3-5倍。曲霉菌IgE（或皮肤点刺试验）诊断哮喘、囊性纤维化、慢性阻塞性肺病和结核病后的曲霉菌致敏，并与肺功能较差和/或病情加重密切相关。世界各地的临床医生和实验室人员需要将这些优秀的新工具纳入主流，以更及时、更准确的方式提供结果，从而改善临床结果。
Significant innovations in the past decade have resulted in more sensitive and faster diagnosis of allergic, chronic and invasive pulmonary aspergillosis, as well as Asper-gillus bronchitis and Aspergillus nodules. This new diagnostic landscape has revealed that the incidence and prevalence of aspergillosis is substantially higher than previously understood, and is summarised in this review. Oral and intravenous antifungal treatment offers good clinical response rates for affected patients. Neverthe-less, missed diagnoses mean that patients are over-treated with antibacterial agents, corticosteroids and anti-TB drugs, resulting in continuing illness and often death. The clinical introduction of several high perform-ing diagnostic tests is helping to redefine patient management. It is well-known that Aspergillus antigen can be detected in 70-95% of bronchoscopy samples in patients with invasive and chronic aspergillosis in less than 1 hour. Aspergillus immunoglobulin G (IgG) (precipitins) is >90% sensitive and >85% specific for chronic and allergic aspergillosis. High-volume respira-tory fungal culture and Aspergillus polymerase chain reaction have 3-5-fold higher sensitivity than routine bacterial culture. Aspergillus IgE (or skin prick testing) diagnoses Aspergillus sensitisation in asthma, cystic fibrosis, chronic obstructive pulmonary disease and post-TB, and correlates well with poorer lung function and/or exacerbations. Clinicians and laboratorians across the world need to mainstream these excellent new tools to improve clinical outcomes by delivering results in a more timely and accurate fashion.