Prospective observational study of respiratory Aspergillus colonization or disease in patients with various stages of chronic obstructive pulmonary disease utilizing culture versus nonculture techniques

Author:

Waqas Sarmad1ORCID,Dunne Katie2,Talento Alida Fe23,Wilson Graham4,Martin-Loeches Ignacio15,Keane Joseph16,Rogers Thomas R23

Affiliation:

1. Department of Clinical Medicine, Trinity College Dublin, Ireland

2. Department of Clinical Microbiology, Trinity College Dublin, Ireland

3. Department of Microbiology, St. James’s Hospital, Dublin 8, Ireland

4. Department of Radiology, St. James’s Hospital, Dublin 8, Ireland

5. Department of Intensive Care Medicine, St. James’s Hospital, Dublin 8, Ireland

6. Department of Respiratory Medicine, St. James’s Hospital, Dublin 8, Ireland

Abstract

Abstract Chronic obstructive pulmonary disease (COPD) patients have been recognized to be at increased risk of Aspergillus spp. colonization, which may progress to invasive pulmonary aspergillosis (IPA). The objective of this study was to determine the frequency of Aspergillus colonization, or disease, in a cohort of COPD patients. A prospective observational study was undertaken to determine Aspergillus colonization, or disease, in consecutive COPD patients undergoing bronchoscopy. Fungal culture as well as galactomannan antigen (GM) and Aspergillus nucleic acid detection (PCR) were performed on bronchoalveolar lavage fluid (BAL) samples. One hundred and fifty patients were recruited. One hundred and twelve (74.7%) were outpatients, 38 (25.33%) were inpatients, of whom 6 (4%) were in the intensive care unit. Most patients (N = 122, 81.3%) were either COPD GOLD (Global Initiative for Chronic Obstructive Lung Disease) stages 1 or 2. Nine (6%) patients were on systemic steroids, 64 (42.7%) on inhaled steroids, and 9 (6%) on both. Seventeen patients (11.3%) had at least one positive test for Aspergillus detection (culture ± galactomannan ± polymerase chain reaction [PCR]), 13 (76.4%) of whom were COPD GOLD stages 1 or 2.  Five patients had probable or putative IPA. Aspergillus sp. was detected in five patients (3.3%) by culture, but detection increased to 17 (11.3%) by the additional testing for GM or Aspergillus DNA. The frequency of Aspergillus detection in this cohort of COPD patients may reflect the predominance of early GOLD stages among the study population but deserves further investigation to determine its relevance as a predictive risk factor for IPA.

Funder

Gilead Sciences via the UK-Ireland Gilead Invasive Fungal Disease Fellowship program 2017

Publisher

Oxford University Press (OUP)

Subject

Infectious Diseases,General Medicine

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