ORIGINAL RESEARCH article
Front. Cell. Infect. Microbiol.
Sec. Fungal Pathogenesis
Volume 15 - 2025 | doi: 10.3389/fcimb.2025.1494522
This article is part of the Research TopicThe Respiratory System Microbiome: Diversity, Function and HealthView all 4 articles
Non-Invasive Monitoring of Aspergillus Infections in Chronic Lung Disease Patients: A Combined Serology and HRCT Imaging Approach
Provisionally accepted
- 1University of Electronic Science and Technology of China, Chengdu, Sichuan Province, China
- 2Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China
- 3Enyang District People's Hospital of Bazhong, Bazhong, Sichuan, China
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Background: Diagnosing Aspergillus infections in patients with chronic pulmonary diseases is challenging, particularly in settings where invasive diagnostic tools are limited. This study explores a non-invasive diagnostic approach, combining serological tests and high-resolution computed tomography (HRCT) imaging, to identify patients who may need further invasive evaluation for Aspergillus infection.Methods: This retrospective study included patients with chronic pulmonary diseases from regional centers who experienced acute exacerbations that did not respond to antibacterial therapy, had positive sputum cultures for Aspergillus species, and lacked typical invasive radiological features on HRCT. Patients were classified based on clinical data, HRCT imaging, and serological markers (IgG, IgM, galactomannan) to distinguish between Aspergillus colonization and clinically diagnosed active infection.Results: Of the 2,731 patients assessed, 209 met the study criteria: 112 were identified with Aspergillus colonization, and 97 with clinically diagnosed Aspergillus infection. Patients with active infection had significantly higher Aspergillus -specific IgG levels (median 185.47 IU/mL vs. 59.96 IU/mL, p<0.001) and higher galactomannan indices, especially those with invasive infection (p<0.001). HRCT scores were strongly correlated with the risk of infection. The combination of IgG levels and HRCT scores achieved an AUC (area under the curve) of 0.9 for differentiating infection from colonization and 0.74 for distinguishing different types of Aspergillus infections.This study supports the use of a non-invasive diagnostic approach, combining serological testing and HRCT imaging, to identify patients with chronic lung diseases who have positive sputum cultures for Aspergillus and are highly suspected of active infection, such as invasive pulmonary aspergillosis and chronic pulmonary aspergillosis, for further invasive diagnostic evaluation. This method is particularly useful in patients who experience frequent acute exacerbations and are unwilling or unable to undergo invasive diagnostic procedures, helping clinicians identify those who really require further definitive evaluation and thereby reducing unnecessary antifungal treatment.
Keywords: Aspergillus infection, chronic lung disease, Non-invasive diagnosis, Serology, HRCT imaging. Trial registration: NCT06379568, Registered 17 April 2024. Retrospectively registered. ClinicalTrials.gov PRS: Record Summary NCT06379568
Received: 11 Sep 2024; Accepted: 04 Jun 2025.
Copyright: © 2025 zhang, Yang, Fang, Xie, Tang and Chen. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Lin Chen, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China
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