SERODIAGNOSIS AND MONITORING OF ASPERGILLUS INFECTIONS AFTER LUNG TRANSPLANTATION

Objective: To determine whether quantification of specific antifungal antibody responses in serum can provide supplemental information for t he diagnosis of Aspergillus fumigatus infections and the monitoring of antifungal treatment in patients after lung transplantation. Design: Retrospective study. Setting: Center for lung transplantation, Univers ity Hospital Groningen, the Netherlands. Patients: 4 patients with pro ven A. fumigatus infections after lung transplantation and fatal outco me. Measurements: The IgG antibody response specific for A. fumigatus antigens was measured by enzyme-linked immunosorbent assay and was com pared with radiographic features, cytologic findings, microbiological cultures, and clinical diagnosis. Results: Increasing IgG antibody res ponses specific for A. fumigatus antigens closely paralleled cytologic or microbiological identification of A. fumigatus from bronchoalveola r ravage fluid and decrease of lung function. Increasing specific IgG antibody responses were found to precede radiographic identification o f lung cavitation by 1 to 2 weeks, precede the diagnosis of aspergillo sis by 2 to 20 weeks, and detect fungal reinfection. In most cases, su ccessful antifungal treatment decreased specific IgG antibody response . A decrease in specific IgG antibody response correlated with the ina bility to culture or identify A. fumigatus in bronchoalveolar lavage f luid and with radiographic and clinical improvement. Conclusions: Spec ific IgG antibody responses in serum correlate with radiographic, cyto logic, and microbiological findings and with the clinical diagnosis of A. fumigatus infections in patients who have had lung transplantation . Increased IgG antibody responses in serum may provide important info rmation that is helpful in the diagnosis and early treatment of pulmon ary fungal infections and in monitoring antifungal treatment.