Monitoring treatment response in chronic pulmonary aspergillosis: role of clinical, spirometric and immunological markers

Objectives: The treatment response in chronic pulmonary aspergillosis (CPA) is usually assessed based on the improvement in clinical and imaging findings. Herein, we evaluate serum Aspergillus fumigatus-specific IgG, serum galactomannan, weight change, and lung function for assessing treatment response in subjects with CPA. Methods: We categorized treatment response as favourable (improved or stable clinical response with radiologically improved or stable disease) or unfavourable (worsening of symptoms or radiological progression) after 6 months of treatment with antifungal azoles. We measured A. fumigatus-specific IgG, serum galactomannan, weight, and lung function at baseline, 3 months, and 6 months in those with favourable and unfavourable treatment response. Results: One hundred and twenty-six consecutive treatment-naive subjects (53.2% (67/126) males; mean +/- SD age, 42.3 +/- 14.7 years) with CPA were included. One hundred and six and 20 were classified as having favourable and unfavourable response, respectively. After 6 months of treatment, the decline in serum A. fumigatus-specific IgG (n = 119) was similar in those with favourable or unfavourable response (mean +/- SD, -26.3 +/- 45.5 mgA/L vs. -3.4 +/- 65.6 mgA/L; p 0.20). There was no significant change in the serum galactomannan (favourable vs. unfavourable: mean +/- SD, -0.11 +/- 2.8 vs. -0.62 +/- 2; p 0.92) or FEV1 (favourable vs. unfavourable: mean +/- SD, 24 +/- 250 mL vs. -62 +/- 154 mL; p 0.19) after 6 months of treatment. There was significant loss of weight (mean +/- SD, -2.5 +/- 4.5 kg) in subjects with unfavourable response. Conclusion: Serum A. fumigatus-specific IgG and serum galactomannan inconsistently decrease following treatment and may not be useful indicators for monitoring treatment response in CPA. Similarly, there is little change in pulmonary function following treatment. A gain in body weight is seen in those with favourable response. (C) 2019 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.