Original articleClinical characteristics of patients with Aspergillus species isolation from respiratory samples: Comparison of chronic pulmonary aspergillosis and colonization
Introduction
Aspergillus species, which are commonly found in humid solid, water, and other materials, can cause a variety of illnesses in humans. We inhale several hundred spores per day and, although these spores are generally cleared from the body without resulting in disease in most people, some are affected by several Aspergillus species that can cause pulmonary diseases, such as allergic bronchopulmonary aspergillosis (ABPA), chronic pulmonary aspergillosis (CPA) and simple aspergilloma [1], even if they are not immunocompromised.
When isolating Aspergillus species from respiratory samples, it is important to confirm whether the isolates simply indicate colonization, meaning that the species are a component of the normal flora and are not pathogenic. In this study, we reviewed the characteristics of patients seen in our hospital, in whom Aspergillus species were isolated from respiratory samples, to clarify the differences in clinical characteristics between CPA and colonization.
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Study design
We retrospectively reviewed the laboratory data of a series of consecutive samples from which Aspergillus species were isolated between January 2002 and December 2011 at the NTT Medical Center Tokyo, Tokyo, Japan. Only patients with Aspergillus species isolates from respiratory samples, without hematological malignancy, were included in this study. The subjects’ electronic medical records were reviewed to obtain clinical and demographic data, including gender; age; category of pulmonary
Results
Fig. 1 shows a diagram of the study cohort. Of the 368 samples with Aspergillus species isolates, 188 were respiratory samples obtained from 125 patients. Fifteen patients were excluded due to hematological malignancy, for a total of 110 patients included in the study.
Table 1 shows the patient characteristics. The median age (range) was 71 years (range: 31–92 years); 64 (58%) were male. The samples were mostly of sputum (85 samples [77%]), followed by bronchoalveolar lavage fluid (23 samples
Discussion
In this study, we reviewed the clinical characteristics of 110 patients with Aspergillus species isolates obtained from respiratory samples. The most frequently isolated Aspergillus species was A. fumigatus, followed by A. niger and A. flavus. Approximately 25% of the patients with Aspergillus isolates from respiratory samples were diagnosed with CPA. The patients with CPA exhibited malnutrition and a different distribution of underlying pulmonary diseases, as well as a poorer prognosis.
In
Conclusions
We herein demonstrated that patients with CPA have clinical characteristics distinct from those seen in individuals with colonization. In particular, the patients with CPA exhibited a shorter survival times than those with colonization. For cases in which Aspergillus species are isolated from respiratory samples, especially in patients with malnutrition and/or a history of tuberculosis, emphysema, or thoracic surgery, it is important to promptly diagnose and treat these patients with
Conflict of interest
The authors have no conflicts of interest.
Acknowledgments
None.
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