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Volume 24, Number 8—August 2018
Online Report

Case Definition of Chronic Pulmonary Aspergillosis in Resource-Constrained Settings

David W. DenningComments to Author , Iain D. Page, Jeremiah Chakaya, Kauser Jabeen, Cecilia M. Jude, Muriel Cornet, Ana Alastruey-Izquierdo, Felix Bongomin, Paul Bowyer, Arunaloke Chakrabarti, Sara Gago, John Guto, Bruno Hochhegger, Martin Hoenigl, Muhammad Irfan, Nicholas Irurhe, Koichi Izumikawa, Bruce Kirenga, Veronica Manduku, Samihah Moazam, Rita O. Oladele, Malcolm D. Richardson, Juan Luis Rodriguez Tudela, Anna Rozaliyani, Helmut J.F. Salzer, Richard Sawyer, Nasilele F. Simukulwa, Alena Skrahina, Charlotte Sriruttan, Findra Setianingrum, Bayu A.P. Wilopo, Donald C. Cole, and Haileyesus Getahun
Author affiliations: University of Manchester, Manchester, UK (D.W. Denning, I.D. Page, F. Bongomin, P. Bowyer, S. Gago, R.O. Oladele, C. Sriruttan, F. Setianingrum, B.A.P. Wilopo); Wythenshawe Hospital Manchester University NHS Foundation Trust, Manchester (D.W. Denning, I.D. Page, S. Moazam, M.D. Richardson, R. Sawyer); The Global Action Fund for Fungal Infections, Geneva, Switzerland (D.W. Denning, J. Guto, J.L. Rodriguez Tudela); Kenya Medical Research Institute, Nairobi, Kenya (J. Chakaya, V. Manduku); Aga Khan University, Karachi, Pakistan (K. Jabeen, M. Irfan); Olive View–UCLA Medical Center, Sylmar, California, USA (C.M. Jude); Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France (M. Cornet); Instituto de Salud Carlos III, Madrid, Spain (A. Alastruey-Izquierdo); Postgraduate Institute of Medical Education and Research, Chandigarh, India (A. Chakrabarti); Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil (B. Hochhegger); University of California San Diego, San Diego, California, USA (M. Hoenigl); Medical University of Graz, Graz, Austria (M. Hoenigl); Center for Biomarker Research in Medicine, Graz (M. Hoenigl); Lagos University Teaching Hospital, Lagos, Nigeria (N. Irurhe); Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan (K. Izumikawa); Mulago Hospital and Makerere University, Kampala, Uganda (B. Kirenga); University of Lagos, Lagos (R.O. Oladele); Universitas Indonesia, Jakarta, Indonesia (A. Rozaliyani, F. Setianingrum); Research Center Borstel, Borstel, Germany (H.J.F. Salzer); Royal Liverpool University Hospital, Liverpool, UK (N.F. Simukulwa); The Republican Scientific and Practical Centre for Pulmonology and TB, Minsk, Belarus (A. Skrahina, C. Sriruttan); National Institute for Communicable Diseases, Johannesburg, South Africa (C. Sriruttan); University of the Witwatersrand, Johannesburg (C. Sriruttan); Universitas Padjadjaran, Bandung, Indonesia (B.A.P. Wilopo); University of Toronto, Toronto, Ontario, Canada (D.C. Cole); World Health Organization, Geneva (H. Getahun)

Main Article

Table 1

Published diagnostic features and criteria for chronic pulmonary aspergillosis*

Parameter
Reference
(21)
(22)
(23)
(24)†
(25)
(26)
Symptoms
>1 of the following for 3 mo: WL, productive cough, hemoptysis plus absence of overt immunosuppression
>1 of the following (no duration specified): fever, WL, sputum production, cough, hemoptysis, fatigue, shortness of breath
Performance status 1–2
All of the following required for 1–6 mo: fever, cough, sputum production, weight loss
>1 of the following for 3 mo: weight loss, productive cough, hemoptysis plus absence of overt immunosuppression
“Significant pulmonary and/or systemic symptoms for 3 months or more”; no specific symptoms listed
Radiology
>1 of the following: cavitary lesion with paracavitary fibrosis, new or expanding cavity on serial imaging
>1 of the following: new infiltrates, cavity formation, expansion of preexisting cavities; with or without the following: pericavitary infiltrates, adjacent pleural thickening
Compatible chest CT scan or photo-graphically confirmed endoscopic lesion
Cavitary pulmonary lesion with evidence of pericavitary infiltrates and adjacent pleural thickening with/without fungal ball
>1 of the following: cavitary lesion with paracavitary fibrosis, new or expanding cavity on serial imaging
Both required: >1 pulmonary cavities with either thick or thin wall, possibly containing aspergilloma or irregular intraluminal material; overt radiologic progression over >3 mo required (new cavities, increasing pericavitary infiltrates, or increasing fibrosis)
Aspergillus antibody/ culture
Either positive precipitins, or, culture from pulmonary or pleural cavity
>1 of the following: platelia serum galactomannan index >1.0, positive precipitins, positive (1,3)-β-D-glucan, evidence of Aspergillus spp. by molecular diagnosis, culture or pathological findings
Positive serologic test required by both of the following: precipitins by CIE with >2 lines, second serologic test positive by any method; and microbiological evidence by 1 of the following sources from BAL or sputum samples: >2 or more positive cultures, 1 positive culture and positive microscopy
Culture from sputum or BAL mandatory, antibodies not required
Either raised Aspergillus-specific IgG or culture from pulmonary or
pleural cavity
If fungal ball present: Aspergillus-IgG/precipitins or other evidence of Aspergillus. If no fungal ball but >1 cavities, then any of the following: Aspergillus-specific IgG, Aspergillus precipitins, strongly positive Aspergillus antigen or DNA in respiratory fluids, percutaneous or excision biopsy showing fungal hyphae on microscopy, growing Aspergillus from a cavity. These tests on respiratory samples not sufficient in isolation: culture, PCR, microscopy
Inflammatory markers
Raised levels of either: CRP, ESR, plasma viscosity
>1 of the following raised: leukocyte count, CRP, ESR
Not required
Not required
Raised levels of either: CRP, ESR
Not required
Exclusion of other pathogens Required with the following examples: mycobacteria, endemic mycoses Lack of improvement with >3 d of broad-spectrum antimicrobial drugs required; patients with infectious diseases 
other than aspergillosis excluded Not required Required with the following examples: TB, other mycoses, granulomatosis with polyangiitis, ABPA, invasive aspergillosis, simple aspergilloma† Not specifically required Required with the following examples: TB, atypical mycobacteria, necrotizing lung cancer, pulmonary infarction, vasculitides, rheumatoid nodule, histoplasmosis/ coccidioidomycosis/ paracoccidioido-mycosis in those with relevant travel history

*ABPA, allergic bronchopulmonary aspergillosis; BAL, bronchoalveolar lavage; CIE, counterimmunoelectrophoresis; CNPA, chronic necrotizing pulmonary aspergillosis; CRP, C-reactive protein: CT, computed tomography; ESR, erythrocyte sedimentation rate; TB, tuberculosis; WL, weight loss.
†This definition includes CNPA cases with 1–3 mo symptoms. Note: precipitins sensitivity even lower than culture. Pleural thickening seems to be a mandatory criterion.

Main Article

References
  1. Goodwin  RA Jr, Owens  FT, Snell  JD, Hubbard  WW, Buchanan  RD, Terry  RT, et al. Chronic pulmonary histoplasmosis. Medicine (Baltimore). 1976;55:41352. DOIPubMedGoogle Scholar
  2. Shah  A, Panjabi  C. Allergic bronchopulmonary aspergillosis: a review of a disease with a worldwide distribution. J Asthma. 2002;39:27389. DOIPubMedGoogle Scholar
  3. Chong  S, Lee  KS, Yi  CA, Chung  MJ, Kim  TS, Han  J. Pulmonary fungal infection: imaging findings in immunocompetent and immunocompromised patients. Eur J Radiol. 2006;59:37183. DOIPubMedGoogle Scholar
  4. Chu  HQ, Li  B, Zhao  L, Huang  DD, Zhang  ZM, Xu  JF, et al. Chest imaging comparison between non-tuberculous and tuberculosis mycobacteria in sputum acid fast bacilli smear-positive patients. Eur Rev Med Pharmacol Sci. 2015;19:242939.PubMedGoogle Scholar
  5. Chiang  CY, Yu  MC, Yang  SL, Yen  MY, Bai  KJ. Surveillance of tuberculosis in Taipei: the influence of nontuberculous mycobacteria. PLoS One. 2015;10:e0142324. DOIPubMedGoogle Scholar
  6. Getahun  H, Harrington  M, O’Brien  R, Nunn  P. Diagnosis of smear-negative pulmonary tuberculosis in people with HIV infection or AIDS in resource-constrained settings: informing urgent policy changes. Lancet. 2007;369:20429. DOIPubMedGoogle Scholar
  7. Schweer  KE, Bangard  C, Hekmat  K, Cornely  OA. Chronic pulmonary aspergillosis. Mycoses. 2014;57:25770. DOIPubMedGoogle Scholar
  8. Pasipanodya  JG, Miller  TL, Vecino  M, Munguia  G, Bae  S, Drewyer  G, et al. Using the St. George respiratory questionnaire to ascertain health quality in persons with treated pulmonary tuberculosis. Chest. 2007;132:15918. DOIPubMedGoogle Scholar
  9. Denning  DW, Pleuvry  A, Cole  DC. Global burden of chronic pulmonary aspergillosis as a sequel to pulmonary tuberculosis. Bull World Health Organ. 2011;89:86472. DOIPubMedGoogle Scholar
  10. Chakaya  J, Kirenga  B, Getahun  H. Long term complications after completion of pulmonary tuberculosis treatment: a quest for a public health approach. J Clin TB Mycobact Dis. 2016;3:102.
  11. World Health Organization. Global Tuberculosis Report. Geneva. Organization. 2015;•••:2015.
  12. Hargreaves  NJ, Kadzakumanja  O, Phiri  S, Lee  CH, Tang  X, Salaniponi  FM, et al. Pneumocystis carinii pneumonia in patients being registered for smear-negative pulmonary tuberculosis in Malawi. Trans R Soc Trop Med Hyg. 2001;95:4028. DOIPubMedGoogle Scholar
  13. Nakiyingi  L, Ssengooba  W, Nakanjako  D, Armstrong  D, Holshouser  M, Kirenga  BJ, et al. Predictors and outcomes of mycobacteremia among HIV-infected smear- negative presumptive tuberculosis patients in Uganda. BMC Infect Dis. 2015;15:62. DOIPubMedGoogle Scholar
  14. Pohl  C, Jugheli  L, Haraka  F, Mfinanga  E, Said  K, Reither  K. Pulmonary aspergilloma: a treatment challenge in sub-Saharan Africa. PLoS Negl Trop Dis. 2013;7:e2352. DOIPubMedGoogle Scholar
  15. British Tuberculosis Association. Aspergillus in persistent lung cavities after tuberculosis. A report from the Research Committee of the British Tuberculosis Association. Tubercle. 1968;49:111. DOIPubMedGoogle Scholar
  16. Smith  NL, Denning  DW. Underlying conditions in chronic pulmonary aspergillosis including simple aspergilloma. Eur Respir J. 2011;37:86572. DOIPubMedGoogle Scholar
  17. The Lancet Respiratory Medicine. Chronic pulmonary aspergillosis: help is on the way. Lancet Respir Med. 2016;4:83. DOIPubMedGoogle Scholar
  18. Patterson  TF, Thompson  GR III, Denning  DW, Fishman  JA, Hadley  S, Herbrecht  R, et al. Practice guidelines for the diagnosis and management of aspergillosis: 2016 update by the Infectious Diseases Society of America. Clin Infect Dis. 2016;63:e160. DOIPubMedGoogle Scholar
  19. Denning  DW, Cadranel  J, Beigelman-Aubry  C, Ader  F, Chakrabarti  A, Blot  S, et al.; European Society for Clinical Microbiology and Infectious Diseases and European Respiratory Society. Chronic pulmonary aspergillosis: rationale and clinical guidelines for diagnosis and management. Eur Respir J. 2016;47:4568. DOIPubMedGoogle Scholar
  20. Kohno  S, Tamura  K, Niki  Y, Izumikawa  K, Oka  S, Ogawa  K, et al. Executive Summary of Japanese Domestic Guidelines for Management of Deep-seated Mycosis 2014. Med Mycol J. 2016;57:E11763. DOIPubMedGoogle Scholar
  21. Denning  DW, Riniotis  K, Dobrashian  R, Sambatakou  H. Chronic cavitary and fibrosing pulmonary and pleural aspergillosis: case series, proposed nomenclature change, and review. Clin Infect Dis. 2003;37(Suppl 3):S26580. DOIPubMedGoogle Scholar
  22. Kohno  S, Izumikawa  K, Ogawa  K, Kurashima  A, Okimoto  N, Amitani  R, et al.; Japan Chronic Pulmonary Aspergillosis Study Group (JCPASG). Intravenous micafungin versus voriconazole for chronic pulmonary aspergillosis: a multicenter trial in Japan. J Infect. 2010;61:4108. DOIPubMedGoogle Scholar
  23. Cadranel  J, Philippe  B, Hennequin  C, Bergeron  A, Bergot  E, Bourdin  A, et al. Voriconazole for chronic pulmonary aspergillosis: a prospective multicenter trial. Eur J Clin Microbiol Infect Dis. 2012;31:32319. DOIPubMedGoogle Scholar
  24. Ohba  H, Miwa  S, Shirai  M, Kanai  M, Eifuku  T, Suda  T, et al. Clinical characteristics and prognosis of chronic pulmonary aspergillosis. Respir Med. 2012;106:7249. DOIPubMedGoogle Scholar
  25. Jhun  BW, Jeon  K, Eom  JS, Lee  JH, Suh  GY, Kwon  OJ, et al. Clinical characteristics and treatment outcomes of chronic pulmonary aspergillosis. Med Mycol. 2013;51:8117. DOIPubMedGoogle Scholar
  26. Kosmidis  C, Denning  DW. The clinical spectrum of pulmonary aspergillosis. Thorax. 2015;70:2707. DOIPubMedGoogle Scholar
  27. Pasqualotto  AC, editor. Aspergillosis: from diagnosis to prevention. 1st ed. New York: Springer; 2010.
  28. Tomlinson  JR, Sahn  SA. Aspergilloma in sarcoid and tuberculosis. Chest. 1987;92:5058. DOIPubMedGoogle Scholar
  29. Camara  B, Reymond  E, Saint-Raymond  C, Roth  H, Brenier-Pinchart  MP, Pinel  C, et al.; Grenoble Aspergillus Committee. Characteristics and outcomes of chronic pulmonary aspergillosis: a retrospective analysis of a tertiary hospital registry. Clin Respir J. 2015;9:6573. DOIPubMedGoogle Scholar
  30. Salzer  HJ, Cornely  OA. Awareness of predictors of mortality may help improve outcome in chronic pulmonary aspergillosis. Eur Respir J. 2017;49:2. DOIPubMedGoogle Scholar
  31. Salzer  HJ, Heyckendorf  J, Kalsdorf  B, Rolling  T, Lange  C. Characterization of patients with chronic pulmonary aspergillosis according to the new ESCMID/ERS/ECMM and IDSA guidelines. Mycoses. 2017;60:13642. DOIPubMedGoogle Scholar
  32. Farid  S, Mohamed  S, Devbhandari  M, Kneale  M, Richardson  M, Soon  SY, et al. Results of surgery for chronic pulmonary Aspergillosis, optimal antifungal therapy and proposed high risk factors for recurrence—a National Centre’s experience. J Cardiothorac Surg. 2013;8:180. DOIPubMedGoogle Scholar
  33. Desai  SR, Hedayati  V, Patel  K, Hansell  DM. Chronic aspergillosis of the lungs: unravelling the terminology and radiology. Eur Radiol. 2015;25:31007. DOIPubMedGoogle Scholar
  34. Franquet  T, Müller  NL, Giménez  A, Guembe  P, de La Torre  J, Bagué  S. Spectrum of pulmonary aspergillosis: histologic, clinical, and radiologic findings. Radiographics. 2001;21:82537. DOIPubMedGoogle Scholar
  35. Denning  DW. Chronic forms of pulmonary aspergillosis. Clin Microbiol Infect. 2001;7(Suppl 2):2531. DOIPubMedGoogle Scholar
  36. Greene  R. The radiological spectrum of pulmonary aspergillosis. Med Mycol. 2005;43(Suppl 1):S14754. DOIPubMedGoogle Scholar
  37. Gadkowski  LB, Stout  JE. Cavitary pulmonary disease. Clin Microbiol Rev. 2008;21:30533. DOIPubMedGoogle Scholar
  38. Gotway  MB, Dawn  SK, Caoili  EM, Reddy  GP, Araoz  PA, Webb  WR. The radiologic spectrum of pulmonary Aspergillus infections. J Comput Assist Tomogr. 2002;26:15973. DOIPubMedGoogle Scholar
  39. Martinez  S, McAdams  HP, Batchu  CS. The many faces of pulmonary nontuberculous mycobacterial infection. AJR Am J Roentgenol. 2007;189:17786. DOIPubMedGoogle Scholar
  40. Jude  CM, Nayak  NB, Patel  MK, Deshmukh  M, Batra  P. Pulmonary coccidioidomycosis: pictorial review of chest radiographic and CT findings. Radiographics. 2014;34:91225. DOIPubMedGoogle Scholar
  41. Jeong  YJ, Lee  KS. Pulmonary tuberculosis: up-to-date imaging and management. AJR Am J Roentgenol. 2008;191:83444. DOIPubMedGoogle Scholar
  42. McAdams  HP, Erasmus  J, Winter  JA. Radiologic manifestations of pulmonary tuberculosis. Radiol Clin North Am. 1995;33:65578.PubMedGoogle Scholar
  43. Ko  JM, Park  HJ, Cho  DG, Kim  CH. CT differentiation of tuberculous and non-tuberculous pleural infection, with emphasis on pulmonary changes. Int J Tuberc Lung Dis. 2015;19:13618. DOIPubMedGoogle Scholar
  44. Izumikawa  K, Ohtsu  Y, Kawabata  M, Takaya  H, Miyamoto  A, Sakamoto  S, et al. Clinical efficacy of micafungin for chronic pulmonary aspergillosis. Med Mycol. 2007;45:2738. DOIPubMedGoogle Scholar
  45. Roberts  CM, Citron  KM, Strickland  B. Intrathoracic aspergilloma: role of CT in diagnosis and treatment. Radiology. 1987;165:1238. DOIPubMedGoogle Scholar
  46. Muldoon  EG, Sharman  A, Page  I, Bishop  P, Denning  DW. Aspergillus nodules; another presentation of Chronic Pulmonary Aspergillosis. BMC Pulm Med. 2016;16:123. DOIPubMedGoogle Scholar
  47. Muniappan  A, Tapias  LF, Butala  P, Wain  JC, Wright  CD, Donahue  DM, et al. Surgical therapy of pulmonary aspergillomas: a 30-year North American experience. Ann Thorac Surg. 2014;97:4328. DOIPubMedGoogle Scholar
  48. Reischies  F, Hoenigl  M. The role of surgical debridement in different clinical manifestations of invasive aspergillosis. Mycoses. 2014;57(Suppl 2):114. DOIPubMedGoogle Scholar
  49. Page  ID, Richardson  MD, Denning  DW. Comparison of six Aspergillus-specific IgG assays for the diagnosis of chronic pulmonary aspergillosis (CPA). J Infect. 2016;72:2409. DOIPubMedGoogle Scholar
  50. Dumollard  C, Bailly  S, Perriot  S, Brenier-Pinchart  MP, Saint-Raymond  C, Camara  B, et al. Prospective evaluation of a new aspergillus IgG enzyme immunoassay kit for diagnosis of chronic and allergic pulmonary aspergillosis. J Clin Microbiol. 2016;54:123642. DOIPubMedGoogle Scholar
  51. Fujiuchi  S, Fujita  Y, Suzuki  H, Doushita  K, Kuroda  H, Takahashi  M, et al. Evaluation of a quantitative serological assay for diagnosing chronic pulmonary aspergillosis. J Clin Microbiol. 2016;54:14969. DOIPubMedGoogle Scholar
  52. Kosmidis  C, Powell  G, Borrow  R, Morris  J, Alachkar  H, Denning  DW. Response to pneumococcal polysaccharide vaccination in patients with chronic and allergic aspergillosis. Vaccine. 2015;33:72715. DOIPubMedGoogle Scholar
  53. Bongomin  F, Harris  C, Foden  P, Kosmidis  C, Denning  DW. Innate and adaptive immune defects in chronic pulmonary aspergillosis. J Fungi (Basel). 2017;3:26. DOIPubMedGoogle Scholar
  54. Döffinger  R, Harris  C, Lear  S, Newton  P, Alachkar  H, Dinakantha  S, et al. Impaired Th1 and Th17 immunity in chronic pulmonary aspergillosis. In: Proceedings of the 6th Advances against Aspergillosis. 6th Advances against Aspergillosis Conference; Feb 27–Mar 1, 2014; Madrid, Spain [cited 2018 May 23]. http://www.advancesagainstaspergillosis.org/2014/index.htm
  55. Page  ID, Richardson  M, Denning  DW. Antibody testing in aspergillosis—quo vadis? Med Mycol. 2015;53:41739. DOIPubMedGoogle Scholar
  56. Kitasato  Y, Tao  Y, Hoshino  T, Tachibana  K, Inoshima  N, Yoshida  M, et al. Comparison of Aspergillus galactomannan antigen testing with a new cut-off index and Aspergillus precipitating antibody testing for the diagnosis of chronic pulmonary aspergillosis. Respirology. 2009;14:7018. DOIPubMedGoogle Scholar
  57. Guitard  J, Sendid  B, Thorez  S, Gits  M, Hennequin  C. Evaluation of a recombinant antigen-based enzyme immunoassay for the diagnosis of noninvasive aspergillosis. J Clin Microbiol. 2012;50:7625. DOIPubMedGoogle Scholar
  58. Baxter  CG, Denning  DW, Jones  AM, Todd  A, Moore  CB, Richardson  MD. Performance of two Aspergillus IgG EIA assays compared with the precipitin test in chronic and allergic aspergillosis. Clin Microbiol Infect. 2013;19:E197204. DOIPubMedGoogle Scholar
  59. Shin  B, Koh  WJ, Jeong  BH, Yoo  H, Park  HY, Suh  GY, et al. Serum galactomannan antigen test for the diagnosis of chronic pulmonary aspergillosis. J Infect. 2014;68:4949. DOIPubMedGoogle Scholar
  60. Oliva  A, Flori  P, Hennequin  C, Dubus  JC, Reynaud-Gaubert  M, Charpin  D, et al. Evaluation of the Aspergillus Western blot IgG kit for diagnosis of chronic aspergillosis. J Clin Microbiol. 2015;53:24854. DOIPubMedGoogle Scholar
  61. Page  ID, Baxter  C, Hennequin  C, Richardson  MD, van Hoeyveld  E, van Toorenenbergen  AW, et al. Receiver operating characteristic curve analysis of four Aspergillus-specific IgG assays for the diagnosis of chronic pulmonary aspergillosis. Diagn Microbiol Infect Dis. 2018;91:4751. DOIPubMedGoogle Scholar
  62. Page  ID, Richardson  MD, van Toorenenbergen  A, Denning  DW. Siemens Immulite Aspergillus-specific IgG assay for chronic pulmonary aspergillosis diagnosis. Med Mycol. 2018 [cited 2018 May 25].
  63. Langridge  PJ, Sheehan  RL, Denning  DW. Microbial yield from physiotherapy assisted sputum production in respiratory outpatients. BMC Pulm Med. 2016;16:23. DOIPubMedGoogle Scholar
  64. Nam  HS, Jeon  K, Um  SW, Suh  GY, Chung  MP, Kim  H, et al. Clinical characteristics and treatment outcomes of chronic necrotizing pulmonary aspergillosis: a review of 43 cases. Int J Infect Dis. 2010;14:e47982. DOIPubMedGoogle Scholar
  65. Fraczek  MG, Kirwan  MB, Moore  CB, Morris  J, Denning  DW, Richardson  MD. Volume dependency for culture of fungi from respiratory secretions and increased sensitivity of Aspergillus quantitative PCR. Mycoses. 2014;57:6978. DOIPubMedGoogle Scholar
  66. Camuset  J, Nunes  H, Dombret  MC, Bergeron  A, Henno  P, Philippe  B, et al. Treatment of chronic pulmonary aspergillosis by voriconazole in nonimmunocompromised patients. Chest. 2007;131:143541. DOIPubMedGoogle Scholar
  67. Cucchetto  G, Cazzadori  A, Conti  M, Cascio  GL, Braggio  P, Concia  E. Treatment of chronic pulmonary aspergillosis with voriconazole: review of a case series. Infection. 2015;43:27786. DOIPubMedGoogle Scholar
  68. Pashley  CH, Fairs  A, Morley  JP, Tailor  S, Agbetile  J, Bafadhel  M, et al. Routine processing procedures for isolating filamentous fungi from respiratory sputum samples may underestimate fungal prevalence. Med Mycol. 2012;50:4338. DOIPubMedGoogle Scholar
  69. Howard  SJ, Cerar  D, Anderson  MJ, Albarrag  A, Fisher  MC, Pasqualotto  AC, et al. Frequency and evolution of Azole resistance in Aspergillus fumigatus associated with treatment failure. Emerg Infect Dis. 2009;15:106876. DOIPubMedGoogle Scholar
  70. Izumikawa  K, Yamamoto  Y, Mihara  T, Takazono  T, Morinaga  Y, Kurihara  S, et al. Bronchoalveolar lavage galactomannan for the diagnosis of chronic pulmonary aspergillosis. Med Mycol. 2012;50:8117. DOIPubMedGoogle Scholar
  71. Fayemiwo  S, Moore  CB, Foden  P, Denning  DW, Richardson  MD. Comparative performance of Aspergillus galactomannan ELISA and PCR in sputum from patients with ABPA and CPA. J Microbiol Methods. 2017;140:329. DOIPubMedGoogle Scholar
  72. Prattes  J, Flick  H, Prüller  F, Koidl  C, Raggam  RB, Palfner  M, et al. Novel tests for diagnosis of invasive aspergillosis in patients with underlying respiratory diseases. Am J Respir Crit Care Med. 2014;190:9229. DOIPubMedGoogle Scholar
  73. Eigl  S, Prattes  J, Lackner  M, Willinger  B, Spiess  B, Reinwald  M, et al. Multicenter evaluation of a lateral-flow device test for diagnosing invasive pulmonary aspergillosis in ICU patients. Crit Care. 2015;19:178. DOIPubMedGoogle Scholar
  74. Godet  C, Alastruey-Izquierdo  A, Flick  H, Hennequin  C, Mikilps-Mikgelbs  R, Munteanu  O, et al.; CPAnet. A CPAnet consensus statement on research priorities for chronic pulmonary aspergillosis: a neglected fungal infection that requires attention. J Antimicrob Chemother. 2018;73:2806. DOIPubMedGoogle Scholar

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