Proposed Diagnostic Criteria for Invasive Pulmonary Aspergillosis in Patients with Autoimmune Inflammatory Rheumatic Diseases: A Proof-of-Concept Study
The EORTC/MSGERC definition lacks sufficient sensitivity for diagnosing invasive pulmonary aspergillosis (IPA) in patients with autoimmune inflammatory rheumatic diseases (AIIRDs). We hypothesized that the partial fulfillment of the EORTC/MSGERC definition can improve its diagnostic sensitivity. Thi...
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MDPI AG
2025-06-01
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| author | Takashi Kurita Koh Okamoto Noritaka Sekiya Ryoichi Hanazawa Akio Yamamoto Tadashi Hosoya Akihiro Hirakawa Shinsuke Yasuda Yoshiaki Gu |
| author_facet | Takashi Kurita Koh Okamoto Noritaka Sekiya Ryoichi Hanazawa Akio Yamamoto Tadashi Hosoya Akihiro Hirakawa Shinsuke Yasuda Yoshiaki Gu |
| author_sort | Takashi Kurita |
| collection | DOAJ |
| description | The EORTC/MSGERC definition lacks sufficient sensitivity for diagnosing invasive pulmonary aspergillosis (IPA) in patients with autoimmune inflammatory rheumatic diseases (AIIRDs). We hypothesized that the partial fulfillment of the EORTC/MSGERC definition can improve its diagnostic sensitivity. This retrospective observational study included patients with AIIRDs on immunosuppressive therapy who underwent serum galactomannan antigen testing for suspected IPA. Patients who fulfilled the clinical features or mycological evidence as per the EORTC/MSGERC definition were considered as having “potential IPA.” We compared the clinical characteristics of 364 patients who were categorized into 3 groups—potential IPA (n = 29), proven/probable IPA (n = 24), and non-IPA (n = 311; not meeting any definition). The potential and proven/probable IPA groups had significantly lower survival rates than the non-IPA group (<i>p</i> < 0.001). The potential IPA (adjusted hazard ratio [aHR], 2.0; 95% confidence interval [CI], 1.1–3.8) and proven/probable IPA (aHR, 2.6; 95% CI, 1.4–4.9) were independent risk factors for mortality. Compared with the EORTC/MSGERC definition, our proposed criteria improved sensitivity based on the diagnosis at the end of observation (50.0%, 100.0%, respectively). The characteristics and mortality rates of patients were similar between the potential and proven/probable IPA groups. Using these criteria for clinical diagnosis may provide high sensitivity. |
| format | Article |
| id | doaj-art-2ea0264d3b9840f9807feadc67bfdbe1 |
| institution | DOAJ |
| issn | 2309-608X |
| language | English |
| publishDate | 2025-06-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Fungi |
| spelling | doaj-art-2ea0264d3b9840f9807feadc67bfdbe12025-08-20T03:16:32ZengMDPI AGJournal of Fungi2309-608X2025-06-0111643710.3390/jof11060437Proposed Diagnostic Criteria for Invasive Pulmonary Aspergillosis in Patients with Autoimmune Inflammatory Rheumatic Diseases: A Proof-of-Concept StudyTakashi Kurita0Koh Okamoto1Noritaka Sekiya2Ryoichi Hanazawa3Akio Yamamoto4Tadashi Hosoya5Akihiro Hirakawa6Shinsuke Yasuda7Yoshiaki Gu8Department of Infectious Diseases, Institute of Science Tokyo, Tokyo 113-8510, JapanDepartment of Infectious Diseases, Institute of Science Tokyo, Tokyo 113-8510, JapanDepartment of Infectious Diseases, Institute of Science Tokyo, Tokyo 113-8510, JapanDepartment of Clinical Biostatistics, Institute of Science Tokyo, Tokyo 113-8510, JapanDepartment of Rheumatology, Institute of Science Tokyo, Tokyo 113-8510, JapanDepartment of Rheumatology, Institute of Science Tokyo, Tokyo 113-8510, JapanDepartment of Clinical Biostatistics, Institute of Science Tokyo, Tokyo 113-8510, JapanDepartment of Rheumatology, Institute of Science Tokyo, Tokyo 113-8510, JapanDepartment of Infectious Diseases, Institute of Science Tokyo, Tokyo 113-8510, JapanThe EORTC/MSGERC definition lacks sufficient sensitivity for diagnosing invasive pulmonary aspergillosis (IPA) in patients with autoimmune inflammatory rheumatic diseases (AIIRDs). We hypothesized that the partial fulfillment of the EORTC/MSGERC definition can improve its diagnostic sensitivity. This retrospective observational study included patients with AIIRDs on immunosuppressive therapy who underwent serum galactomannan antigen testing for suspected IPA. Patients who fulfilled the clinical features or mycological evidence as per the EORTC/MSGERC definition were considered as having “potential IPA.” We compared the clinical characteristics of 364 patients who were categorized into 3 groups—potential IPA (n = 29), proven/probable IPA (n = 24), and non-IPA (n = 311; not meeting any definition). The potential and proven/probable IPA groups had significantly lower survival rates than the non-IPA group (<i>p</i> < 0.001). The potential IPA (adjusted hazard ratio [aHR], 2.0; 95% confidence interval [CI], 1.1–3.8) and proven/probable IPA (aHR, 2.6; 95% CI, 1.4–4.9) were independent risk factors for mortality. Compared with the EORTC/MSGERC definition, our proposed criteria improved sensitivity based on the diagnosis at the end of observation (50.0%, 100.0%, respectively). The characteristics and mortality rates of patients were similar between the potential and proven/probable IPA groups. Using these criteria for clinical diagnosis may provide high sensitivity.https://www.mdpi.com/2309-608X/11/6/437aspergillosisautoimmune diseasesdiagnosisimmunosuppressed hostinvasive pulmonary aspergillosis |
| spellingShingle | Takashi Kurita Koh Okamoto Noritaka Sekiya Ryoichi Hanazawa Akio Yamamoto Tadashi Hosoya Akihiro Hirakawa Shinsuke Yasuda Yoshiaki Gu Proposed Diagnostic Criteria for Invasive Pulmonary Aspergillosis in Patients with Autoimmune Inflammatory Rheumatic Diseases: A Proof-of-Concept Study Journal of Fungi aspergillosis autoimmune diseases diagnosis immunosuppressed host invasive pulmonary aspergillosis |
| title | Proposed Diagnostic Criteria for Invasive Pulmonary Aspergillosis in Patients with Autoimmune Inflammatory Rheumatic Diseases: A Proof-of-Concept Study |
| title_full | Proposed Diagnostic Criteria for Invasive Pulmonary Aspergillosis in Patients with Autoimmune Inflammatory Rheumatic Diseases: A Proof-of-Concept Study |
| title_fullStr | Proposed Diagnostic Criteria for Invasive Pulmonary Aspergillosis in Patients with Autoimmune Inflammatory Rheumatic Diseases: A Proof-of-Concept Study |
| title_full_unstemmed | Proposed Diagnostic Criteria for Invasive Pulmonary Aspergillosis in Patients with Autoimmune Inflammatory Rheumatic Diseases: A Proof-of-Concept Study |
| title_short | Proposed Diagnostic Criteria for Invasive Pulmonary Aspergillosis in Patients with Autoimmune Inflammatory Rheumatic Diseases: A Proof-of-Concept Study |
| title_sort | proposed diagnostic criteria for invasive pulmonary aspergillosis in patients with autoimmune inflammatory rheumatic diseases a proof of concept study |
| topic | aspergillosis autoimmune diseases diagnosis immunosuppressed host invasive pulmonary aspergillosis |
| url | https://www.mdpi.com/2309-608X/11/6/437 |
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