SEROLOGIC MONITORING OF DISEASE AND TREATMENT IN A PATIENT WITH PULMONARY ASPERGILLOMA

Disease progression and efficacy of fungistatic treatment in pulmonary aspergilloma (PA) are difficult to monitor. The usefulness of chest t omography, IgG-ELISA serology, double immunodiffusion, and IgG-immunob lotting was assessed in monitoring disease progression and efficacy of itraconazole treatment during a 9-yr follow-up of a patient with two exacerbations of PA. A rise in IgG-ELISA titer coincided with a recrud escence of clinical symptoms, whereas a decrease after tre;atment para lleled clinical improvement. IgG-binding to a 32-kD serine protease en d to 60- and 94-kD proteins produced with collagen-containing culture medium closely corresponded with IgG-ELISA titers. IgG-binding to a 40 -kD metalloprotease remained at very low levels until symptoms and fun gal growth became well advanced, when a sharp rise was seen. Responses to all antigens rapidly diminished after the start of successful trea tment with itraconazole. Serology may be a useful adjunct in the monit oring of disease progression and the efficacy of itraconazole treatmen t in patients with PA. IgG-binding to individual fungal proteins shows subtle differences in kinetics. Immunologic responses to fungal prote ases raised with collagen-containing culture media may reflect fungal proteolytic involvement during disease progression and treatment more closely than responses to proteins raised with conventional media.