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Aspergillus fumigatus Detection and Risk Factors in Patients with COPD-Bronchiectasis Overlap
Stephanie Everaerts1,2, Katrien Lagrou3,4, Kristina Vermeersch5
1Department of Respiratory Diseases, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium. stephanie.everaerts@kuleuven.be.
Abstract:
The role of Aspergillus fumigatus in the airways of chronic obstructive pulmonary disease (COPD) patients with bronchiectasis is currently unclear. We searched for a sensitive and noninvasive method for A. fumigatus detection in the sputum of COPD patients and addressed potential risk factors for its presence. Induced sputum samples of 18 COPD patients and 17 COPD patients with bronchiectasis were analyzed for the presence of A. fumigatus by culture, galactomannan detection, and PCR. Of the patients with COPD-bronchiectasis overlap, 23.5% had a positive culture for A. fumigatus versus 10.5% of COPD patients without bronchiectasis (p = 0.39). The median sputum galactomannan optical density index was significantly higher in patients with COPD and bronchiectasis compared with patients with COPD alone (p = 0.026) and ranged between the levels of healthy controls and A. fumigatus-colonized cystic fibrosis patients. Both the presence of bronchiectasis and the administration of systemic corticosteroids were associated with sputum galactomannan (p = 0.0028 and p = 0.0044, respectively) and showed significant interaction (p interaction = 0.022). PCR for Aspergillus was found to be a less sensitive method, but was critically dependent on the extraction technique. The higher sputum galactomannan levels suggest a more abundant presence of A. fumigatus in the airways of patients with COPD-bronchiectasis overlap compared with patients with COPD without bronchiectasis, particularly when systemic corticosteroids are administered.
Insights
Aspergillus fumigatus is more prevalent in COPD patients with bronchiectasis, especially those on corticosteroids. Sputum galactomannan is a sensitive indicator for its presence in these patients.
Area of Science:
- Pulmonary Medicine
- Infectious Diseases
- Microbiology
Background:
- The role of Aspergillus fumigatus in chronic obstructive pulmonary disease (COPD) with bronchiectasis is not well understood.
- A sensitive, non-invasive method for detecting A. fumigatus in COPD patient sputum is needed.
- Investigating risk factors for A. fumigatus presence in COPD patients is crucial.
Purpose of the Study:
- To assess the prevalence of Aspergillus fumigatus in COPD patients with and without bronchiectasis.
- To evaluate sputum galactomannan and PCR as diagnostic methods for A. fumigatus detection.
- To identify risk factors associated with A. fumigatus presence in COPD airways.
Main Methods:
- Induced sputum samples from 18 COPD patients and 17 COPD patients with bronchiectasis were analyzed.
- Detection methods included culture, galactomannan assay, and PCR for Aspergillus.
- Statistical analysis was performed to compare groups and identify associated factors.
Main Results:
- Sputum galactomannan levels were significantly higher in COPD patients with bronchiectasis compared to those without (p=0.026).
- Presence of bronchiectasis (p=0.0028) and systemic corticosteroid use (p=0.0044) were associated with higher galactomannan levels.
- PCR sensitivity was dependent on the extraction technique, while culture showed lower prevalence rates.
Conclusions:
- Higher sputum galactomannan suggests a more abundant presence of Aspergillus fumigatus in COPD patients with bronchiectasis.
- Bronchiectasis and corticosteroid use are key factors associated with A. fumigatus presence.
- Sputum galactomannan shows promise as a non-invasive marker for A. fumigatus in this patient group.
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