Klinik Örneklerden İzole edilen Aspergillus Türlerinin Tanısal Önemi

Yıl 2020, Cilt: 11 Sayı: 1, 94 - 100, 27.04.2020

Ravıl Huseynov Samır Javadov Hagigat Kadyrova İskender Karaltı Bayram Taqıyev Shahla Asgarova Leyla Hashımova

Öz

Aspergilloz, kapalı alanlarda və çevrede bulunan Aspergillus mantarı ile oluşan enfeksiyondur. İmmune sistemi baskılanmış kişilerde ve altta yatan akciğer hastalıkları olan hastalarda Aspergillus sporları çeşitli patolojik durumlara neden olabilir. Her yıl 200000 yeni invaziv aspergilloz (IA) vakası kayıt edilmektedir. Kronik obstrüktif akciğer hastalığı (KOAH) olan hastalarında IA'ya bağlı mortalite %72-95 arasında değişmektedir. 3 milyon insan farklı kronik pulmoner aspergilloz (KPA) formları ile hastadır. Araştırmanın amacı, Aspergillus türlerinin görülme sıklığını ve klinik örneklerde tanısal önemini belirlemektir.Ağustos 2017'den Ağustos 2018'e kadar olan periyotda 1170 hastanın örneği Aspergillus spp'in tespiti için incelenmiştir. Toplanan örnekler, kloramfenikollü Sabouraud dekstroz agarına inoküle edildi ve 10 gün boyunca 37°C'de inkübe edildi. Küf kolonilerinin üremesi durumunda, makroskobik ve mikroskobik özelliklere dayalı ileri tanımlama yapılmıştır. 22 hastada (1.88%) Aspergillus spp. kolonisinin ürediği tespit edildi. Onlardan 16'sı erkek, 6'sı kadındı. 7 hastada KOAH, 7 hastada bronşiyal astım (BA), 4 hastada akciğer tüberkulozu (AT), 1 hastada akut solunum yetmezliği, 1 hastada bronşektazi, 1 hastada eksüdatif plörezi, 1 hastada da akut lösemi vardı. Dört farkı Aspergillus türü izole edildi: A. niger, A. fumigatus, A. flavus ve A. terreus. A. niger genellikle BA ile ilişkiliyken, KOAH ve AT hastalarında A. fumigatus hakimdi. KOAH ve AT'lu hastalarda aspergilloz riskinin uygun tedavi sağlamak için ve mortalite oranlarını azaltmak maksadıyla dikkate alınması gerektiğini düşünüyoruz.

Anahtar Kelimeler

Aspergillus spp., invaziv aspergilloz, kronik pulmoner aspergilloz, kronik obstrüktif akciğer hastalığı, akciğer tüberkulozu

Diagnostic Significance of Aspergillus Species Isolated from Clinical Specimens

Öz

Aspergillosis is an infection caused by Aspergillus, ubiquitous mold found in indoor and outdoor air. In patients with immune suppression and underlying lung diseases Aspergillus spores are able to cause various pathologic conditions. Annually 200000 new cases of invasive aspergillosis (IA) are registered. Mortality due to IA in chronic obstructive pulmonary diseases (COPD) patients varies within 72-95%. 3 million people suffer from different forms of chronic pulmonary aspergillosis (CPA). The aim of the investigation was to determine the incidence of Aspergillus species and their diagnostic significance in clinical samples. Specimens of 1170 patients were investigated for the presence of Aspergillus spp. for period from august 2017 to august 2018. The collected specimens were inoculated onto Sabouraud dextrose agar with chloramphenicol and incubated at 37 ˚С temperature for 10 days. In case of growth of mold colonies, further identification was performed based on macroscopic and microscopic features. Growth of Aspergillus spp. colonies were detected in 22 patients (1.88%). 16 of them were males, 6 – females. 7 patients had COPD, 7- bronchial asthma (BA), 4 – pulmonary tuberculosis (PT), 1 – acute respiratory insufficiency, 1 – bronchiectatic disease, 1 – exudative pleurisy and 1 – acute leucosis. Four different species were isolated: Aspergillus niger, A. fumigatus, A. flavus, and A. terreus. A. niger commonly was associated with BA, while in patients with COPD and PT prevailed A. fumigatus. We consider that in patients with COPD and PT risk of aspergillosis should be taken into account in order to provide them with appropriate treatment and reduce mortality rates

Anahtar Kelimeler

Aspergillus spp., invasive aspergillosis, chronic pulmonary aspergillosis, chronic obstructive pulmonary disease, pulmonary tuberculosis

Kaynakça

• Addrizzo-Harris, D. J., Harkin, T. J., McGuinness, G., Naidich, D. P. and Rom, W. N. (1997). Pulmonary aspergilloma and AIDS. A comparison of HIV-infected and HIV-negative individuals. Chest, 111(3), 612-618.
• Ascioglu, S., Rex, J. H., de Pauw, B., Bennett, J. E., Bille, J., Crokaert, F., Denning, D. W., Donnelly, J. P., Edwards, J. E., Erjavec, Z., Fiere, D., Lortholary, O., Maertens, J., Meis, J. F., Patterson, T. F., Ritter, J., Selleslag, D., Shah, P. M., Stevens, D. A. and Walsh, T. (2002). Defining opportunistic invasive fungal infections in immunocompromised patients with cancer and hematopoietic stem cell transplants: an international consensus. Clin Infect Dis, 34(1), 7-14.
• Bao, Z., Chen, H., Zhou, M., Shi, G., Li, Q. and Wan, H. (2017). Invasive pulmonary aspergillosis in patients with chronic obstructive pulmonary disease: a case report and review of the literature. Oncotarget, 8(23), 38069-38074.
• Bulpa, P., Dive, A. and Sibille, Y. (2007). Invasive pulmonary aspergillosis in patients with chronic obstructive pulmonary disease. Eur Respir J, 30(4), 782-800. Camuset, J., Nunes, H., Dombret, M. C., Bergeron, A., Henno, P., Philippe, B., Dauriat, G., Mangiapan, G., Rabbat, A. andCadranel, J. (2007). Treatment of chronic pulmonary aspergillosis by voriconazole in nonimmunocompromised patients. Chest, 131(5), 1435-1441.
• Chakrabarti, A., Chatterjee, S. S., Das, A. and Shivaprakash, M. R. (2011). Invasive aspergillosis in developing countries. Med Mycol, 49 Suppl 1, S35-47.
• Chen, J. C., Chang, Y. L., Luh, S. P., Lee, J. M. and Lee, Y. C. (1997). Surgical treatment for pulmonary aspergilloma: a 28 year experience. Thorax, 52(9), 810-813.
• De Pauw, B., Walsh, T. J., Donnelly, J. P., Stevens, D. A., Edwards, J. E., Calandra, T., Pappas, P. G., Maertens, J., Lortholary, O., Kauffman, C. A., Denning, D., Patterson, T. F., Maschmeyer, G., Bille, J., Dismukes, W. E., Herbrecht, R., Hope, W. W., Kibbler, C., Kullberg, B. J, Marr, K.A., Muñoz, P., Odds F.C., Perfect, J. R., Restrepo, A., Ruhnke, M., Segal, B. H., Sobel, J.D., Sorrell, T.C., Viscoli C., Wingard, J. R., Zaoutis, T. and Bennett, J. E. (2008). Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group. Clin Infect Dis, 46(12), 1813-1821.
• Denning, D. W., Cadranel, J., Beigelman-Aubry, C., Ader, F., Chakrabarti, A., Blot, S., Ullmann, A. J., Dimopoulos, G. and Lange, C. (2016). Chronic pulmonary aspergillosis: rationale and clinical guidelines for diagnosis and management. Eur Respir J, 47(1), 45-68.
• Denning, D. W., Pleuvry, A. and Cole, D. C. (2011). Global burden of chronic pulmonary aspergillosis as a sequel to pulmonary tuberculosis. Bull World Health Organ, 89(12), 864-872.
• Denning, D. W., Pleuvry, A. and Cole, D. C. (2013). Global burden of allergic bronchopulmonary aspergillosis with asthma and its complication chronic pulmonary aspergillosis in adults. Med Mycol, 51(4), 361-370.
• Denning, D. W., Riniotis, K., Dobrashian, R. and Sambatakou, H. (2003). Chronic cavitary and fibrosing pulmonary and pleural aspergillosis: case series, proposed nomenclature change, and review. Clin Infect Dis, 37 Suppl 3, S265-280.
• Guinea, J., Torres-Narbona, M., Gijon, P., Munoz, P., Pozo, F., Pelaez, T., de Miguel, J. and Bouza, E. (2010). Pulmonary aspergillosis in patients with chronic obstructive pulmonary disease: incidence, risk factors, and outcome. Clin Microbiol Infect, 16(7), 870-877.
• Horvath, J. A. and Dummer, S. (1996). The use of respiratory-tract cultures in the diagnosis of invasive pulmonary aspergillosis. Am J Med, 100(2), 171-178. Khasawneh, F., Mohamad, T., Moughrabieh, M. K., Lai, Z., Ager, J. and Soubani, A. O. (2006). Isolation of Aspergillus in critically ill patients: a potential marker of poor outcome. J Crit Care, 21(4), 322-327.
• Kosmidis, C. and Denning, D. W. (2015). The clinical spectrum of pulmonary aspergillosis. Thorax, 70(3), 270-277.
• Latge, J. P. (1999). Aspergillus fumigatus and aspergillosis. Clin Microbiol Rev, 12(2), 310-350.
• Leck, A. (1999). Preparation of lactophenol cotton blue slide mounts. Community Eye Health, 12(30), 24.
• Levy, H., Horak, D. A., Tegtmeier, B. R., Yokota, S. B. and Forman, S. J. (1992). The value of bronchoalveolar lavage and bronchial washings in the diagnosis of invasive pulmonary aspergillosis. Respir Med, 86(3), 243-248.
• Marchetti, O., Lamoth, F., Mikulska, M., Viscoli, C., Verweij, P. and Bretagne, S. (2012). ECIL recommendations for the use of biological markers for the diagnosis of invasive fungal diseases in leukemic patients and hematopoietic SCT recipients. Bone Marrow Transplant, 47(6), 846-854.
• Mathers, C. D. and Loncar, D. (2006). Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med, 3(11), e442.
• May, S. M. and Li, J. T. (2015). Burden of chronic obstructive pulmonary disease: healthcare costs and beyond. Allergy Asthma Proc, 36(1), 4-10.
• McClenny, N. (2005). Laboratory detection and identification of Aspergillus species by microscopic observation and culture: the traditional approach. Med Mycol, 43 Suppl 1, S125-128.
• Meersseman, W., Vandecasteele, S. J., Wilmer, A., Verbeken, E., Peetermans, W. E. and Van Wijngaerden, E. (2004). Invasive aspergillosis in critically ill patients without malignancy. Am J Respir Crit Care Med, 170(6), 621-625.
• Nam, H. S., Jeon, K., Um, S. W., Suh, G. Y., Chung, M. P., Kim, H., Kwon, O. J. and Koh, W. J. (2010). Clinical characteristics and treatment outcomes of chronic necrotizing pulmonary aspergillosis: a review of 43 cases. Int J Infect Dis, 14(6), e479-482.
• Patel, D. A., Gao, X., Stephens, J. M., Forshag, M. S. and Tarallo, M. (2011). US hospital database analysis of invasive aspergillosis in the chronic obstructive pulmonary disease non-traditional host. J Med Econ, 14(2), 227-237.
• Perfect, J. R., Cox, G. M., Lee, J. Y., Kauffman, C. A., de Repentigny, L., Chapman, S. W., Morrison, V. A., Pappas, P., Hiemenz, J. W. and Stevens, D. A. (2001). The impact of culture isolation of Aspergillus species: a hospital-based survey of aspergillosis. Clin Infect Dis, 33(11), 1824-1833.
• Ribaud, P., Chastang, C., Latge, J. P., Baffroy-Lafitte, L., Parquet, N., Devergie, A., Espérou, H., Sélimi, F., Rocha, V., Espérou, H., Sélimi, F., Rocha, V., Derouin, F., Socié, G. and Gluckman, E.. (1999). Survival and prognostic factors of invasive aspergillosis after allogeneic bone marrow transplantation. Clin Infect Dis, 28(2), 322-330.
• Samson, R. A., Visagie, C. M., Houbraken, J., Hong, S. B., Hubka, V., Klaassen, C. H. W., Perrone, G., Seifert, K. A., Susca, A., Tanney, J. B., Varga, J., Kocsubé, S., Szigeti, G., Yaguchi, T. and Frisvad, J. C. (2014). Phylogeny, identification and nomenclature of the genus Aspergillus. Studies in Mycology, 78, 141-173.
• Schmiedel, Y. and Zimmerli, S. (2016). Common invasive fungal diseases: an overview of invasive candidiasis, aspergillosis, cryptococcosis, and Pneumocystis pneumonia. Swiss Med Wkly, 146, w14281.
• Shah, R., Vaideeswar, P. and Pandit, S. P. (2008). Pathology of pulmonary aspergillomas. Indian J Pathol Microbiol, 51(3), 342-345.
• Shahi, M., Ayatollahi Mousavi, S. A., Nabili, M., Aliyali, M., Khodavaisy, S. and Badali, H. (2015). Aspergillus colonization in patients with chronic obstructive pulmonary disease. Curr Med Mycol, 1(3), 45-51.
• Smith, N. L. and Denning, D. W. (2011). Underlying conditions in chronic pulmonary aspergillosis including simple aspergilloma. Eur Respir J, 37(4), 865-872.
• Soubani, A. O., Khanchandani, G. and Ahmed, H. P. (2004). Clinical significance of lower respiratory tract Aspergillus culture in elderly hospitalized patients. Eur J Clin Microbiol Infect Dis, 23(6), 491-494.
• Tashiro, T., Izumikawa, K., Tashiro, M., Takazono, T., Morinaga, Y., Yamamoto, K., Imamura, Y., Miyazaki, T., Seki, M., Kakeya, H., Yamamoto, Y., Yanagihara, K., Yasuoka, A. and Kohno, S. (2011). Diagnostic significance of Aspergillus species isolated from respiratory samples in an adult pneumology ward. Med Mycol, 49(6), 581-587.
• Treger, T. R., Visscher, D. W., Bartlett, M. S. and Smith, J. W. (1985). Diagnosis of pulmonary infection caused by Aspergillus: usefulness of respiratory cultures. J Infect Dis, 152(3), 572-576.
• Uffredi, M. L., Mangiapan, G., Cadranel, J. and Kac, G. (2003). Significance of Aspergillus fumigatus isolation from respiratory specimens of nongranulocytopenic patients. Eur J Clin Microbiol Infect Dis, 22(8), 457-462.
• Xu, H., Li, L., Huang, W. J., Wang, L. X., Li, W. F. and Yuan, W. F. (2012). Invasive pulmonary aspergillosis in patients with chronic obstructive pulmonary disease: a case control study from China. Clin Microbiol Infect, 18(4), 403-408.