Invasive pulmonary aspergillosis in acute exacerbation of chronic obstructive pulmonary disease and the diagnostic value of combined serological tests

ABSTRACT

Invasive pulmonary aspergillosis [IPA] among patients with chronic obstructive pulmonary disease [COPD] is increasing in frequency. We conducted this study to find out the approximate incidence of IPA in patients with acute exacerbation of COPD [AECOPD], and to determine whether using a combination of two tests [galactomannan [CM] antigen and 1,3-[3-glucan [BG] detection] would result in a more specific diagnosis of IPA. The study included 261 patients with AECOPD admitted over two years. The patients were categorized according to the modified definitions for IPA. CM antigen and BG were detected by the Platelia Aspergillus and Glucatell tests. Two patients had proven IPA, three had probable IPA, and two had possible IPA. The rate of proven or probable IPA in patients with AECOPD was 1.91% [5/261]. Four patients with proven and probable IPA had been treated with a systemic or inhaled corticosteroid before hospitalization and the typical symptoms and diagnostic signs of IPA were relatively less common in them. Mortality in patients with proven and probable IPA was 80%. The specificity of combined CM and BG detection was 98.8%. Combining two serological tests increased the specificity of diagnosis but further trials are needed to prove the value of this approach: