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Novel immunologic classification of aspergillosis in adult cystic fibrosis

Background Patients with cystic fibrosis (CF) demonstrate a wide range of hypersensitivity responses toAspergillus, beyond allergic bronchopulmonary aspergillosis, which require classification. Objective This study integrated 2 new methods ofAspergillusdetection--sputum galactomannan (GM) and real-t... Full description

Journal Title: Journal of Allergy and Clinical Immunology Sep 2013, Vol.132(3), pp.560-566
Main Author: Baxter, Caroline
Other Authors: Dunn, Graham , Jones, Andrew , Webb, Kevin , Gore, Robin , Richardson, Malcolm , Denning, David
Format: Electronic Article Electronic Article
Language: English
Subjects:
ID: ISSN: 00916749 ; DOI: 10.1016/j.jaci.2013.04.007
Link: http://search.proquest.com/docview/1554582776/?pq-origsite=primo
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title: Novel immunologic classification of aspergillosis in adult cystic fibrosis
format: Article
creator:
  • Baxter, Caroline
  • Dunn, Graham
  • Jones, Andrew
  • Webb, Kevin
  • Gore, Robin
  • Richardson, Malcolm
  • Denning, David
subjects:
  • Cystic Fibrosis
  • Classification
  • Staphylococcus Infections
  • Body Mass Index
  • Deoxyribonucleic Acid–DNA
  • Patients
  • Genetic Testing
  • Methods
ispartof: Journal of Allergy and Clinical Immunology, Sep 2013, Vol.132(3), pp.560-566
description: Background Patients with cystic fibrosis (CF) demonstrate a wide range of hypersensitivity responses toAspergillus, beyond allergic bronchopulmonary aspergillosis, which require classification. Objective This study integrated 2 new methods ofAspergillusdetection--sputum galactomannan (GM) and real-time PCR--alongside established serologic markers, to reclassify aspergillosis in CF. Methods A total of 146 adult patients with CF had serologic tests (ImmunoCap total IgE, specificAspergillus fumigatusIgE, and specificA fumigatusIgG), sputum real-timeAspergillusPCR, and sputum GM. Patients were classified by using latent class analysis. Results Both RT-PCR and GM were more sensitive than culture in detectingAspergillusin sputum (culture 37%, RT-PCR 74%, and GM 46%). Intraassay and interassay reproducibility of PCR and GM was excellent. Latent class analysis of triazole-naive patients identified a nondiseased group and 3 disease classes: class 1 (n = 49, 37.7%) represented patients with or without positive RT-PCR but no immunologic response toA fumigatusand negative GM (nondiseased); class 2 (n = 23, 17.7%) represented patients with positive RT-PCR, elevated total and specificA fumigatusIgE/IgG, and positive GM (serologic allergic bronchopulmonary aspergillosis); class 3 (n = 19, 14.6%) represented patients with or without positive RT-PCR, elevatedA fumigatusIgE (not IgG), and negative GM (Aspergillussensitized); and class 4 (n = 39, 30%) represented patients with positive RT-PCR, elevatedA fumigatusIgG (not IgE), and positive GM (Aspergillusbronchitis). Conclusions Three distinct classes of aspergillosis in CF were identified by latent class analysis by using serologic, RT-PCR, and GM data. This novel classification will facilitate improved phenotyping, pathogenesis studies, and management evaluations.
language: eng
source:
identifier: ISSN: 00916749 ; DOI: 10.1016/j.jaci.2013.04.007
fulltext: fulltext
issn:
  • 00916749
  • 0091-6749
url: Link


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titleNovel immunologic classification of aspergillosis in adult cystic fibrosis
creatorBaxter, Caroline ; Dunn, Graham ; Jones, Andrew ; Webb, Kevin ; Gore, Robin ; Richardson, Malcolm ; Denning, David
ispartofJournal of Allergy and Clinical Immunology, Sep 2013, Vol.132(3), pp.560-566
identifierISSN: 00916749 ; DOI: 10.1016/j.jaci.2013.04.007
subjectCystic Fibrosis ; Classification ; Staphylococcus Infections ; Body Mass Index ; Deoxyribonucleic Acid–DNA ; Patients ; Genetic Testing ; Methods
descriptionBackground Patients with cystic fibrosis (CF) demonstrate a wide range of hypersensitivity responses toAspergillus, beyond allergic bronchopulmonary aspergillosis, which require classification. Objective This study integrated 2 new methods ofAspergillusdetection--sputum galactomannan (GM) and real-time PCR--alongside established serologic markers, to reclassify aspergillosis in CF. Methods A total of 146 adult patients with CF had serologic tests (ImmunoCap total IgE, specificAspergillus fumigatusIgE, and specificA fumigatusIgG), sputum real-timeAspergillusPCR, and sputum GM. Patients were classified by using latent class analysis. Results Both RT-PCR and GM were more sensitive than culture in detectingAspergillusin sputum (culture 37%, RT-PCR 74%, and GM 46%). Intraassay and interassay reproducibility of PCR and GM was excellent. Latent class analysis of triazole-naive patients identified a nondiseased group and 3 disease classes: class 1 (n = 49, 37.7%) represented patients with or without positive RT-PCR but no immunologic response toA fumigatusand negative GM (nondiseased); class 2 (n = 23, 17.7%) represented patients with positive RT-PCR, elevated total and specificA fumigatusIgE/IgG, and positive GM (serologic allergic bronchopulmonary aspergillosis); class 3 (n = 19, 14.6%) represented patients with or without positive RT-PCR, elevatedA fumigatusIgE (not IgG), and negative GM (Aspergillussensitized); and class 4 (n = 39, 30%) represented patients with positive RT-PCR, elevatedA fumigatusIgG (not IgE), and positive GM (Aspergillusbronchitis). Conclusions Three distinct classes of aspergillosis in CF were identified by latent class analysis by using serologic, RT-PCR, and GM data. This novel classification will facilitate improved phenotyping, pathogenesis studies, and management evaluations.
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titleNovel immunologic classification of aspergillosis in adult cystic fibrosis
descriptionBackground Patients with cystic fibrosis (CF) demonstrate a wide range of hypersensitivity responses toAspergillus, beyond allergic bronchopulmonary aspergillosis, which require classification. Objective This study integrated 2 new methods ofAspergillusdetection--sputum galactomannan (GM) and real-time PCR--alongside established serologic markers, to reclassify aspergillosis in CF. Methods A total of 146 adult patients with CF had serologic tests (ImmunoCap total IgE, specificAspergillus fumigatusIgE, and specificA fumigatusIgG), sputum real-timeAspergillusPCR, and sputum GM. Patients were classified by using latent class analysis. Results Both RT-PCR and GM were more sensitive than culture in detectingAspergillusin sputum (culture 37%, RT-PCR 74%, and GM 46%). Intraassay and interassay reproducibility of PCR and GM was excellent. Latent class analysis of triazole-naive patients identified a nondiseased group and 3 disease classes: class 1 (n = 49, 37.7%) represented patients with or without positive RT-PCR but no immunologic response toA fumigatusand negative GM (nondiseased); class 2 (n = 23, 17.7%) represented patients with positive RT-PCR, elevated total and specificA fumigatusIgE/IgG, and positive GM (serologic allergic bronchopulmonary aspergillosis); class 3 (n = 19, 14.6%) represented patients with or without positive RT-PCR, elevatedA fumigatusIgE (not IgG), and negative GM (Aspergillussensitized); and class 4 (n = 39, 30%) represented patients with positive RT-PCR, elevatedA fumigatusIgG (not IgE), and positive GM (Aspergillusbronchitis). Conclusions Three distinct classes of aspergillosis in CF were identified by latent class analysis by using serologic, RT-PCR, and GM data. This novel classification will facilitate improved phenotyping, pathogenesis studies, and management evaluations.
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titleNovel immunologic classification of aspergillosis in adult cystic fibrosis
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abstractBackground Patients with cystic fibrosis (CF) demonstrate a wide range of hypersensitivity responses toAspergillus, beyond allergic bronchopulmonary aspergillosis, which require classification. Objective This study integrated 2 new methods ofAspergillusdetection--sputum galactomannan (GM) and real-time PCR--alongside established serologic markers, to reclassify aspergillosis in CF. Methods A total of 146 adult patients with CF had serologic tests (ImmunoCap total IgE, specificAspergillus fumigatusIgE, and specificA fumigatusIgG), sputum real-timeAspergillusPCR, and sputum GM. Patients were classified by using latent class analysis. Results Both RT-PCR and GM were more sensitive than culture in detectingAspergillusin sputum (culture 37%, RT-PCR 74%, and GM 46%). Intraassay and interassay reproducibility of PCR and GM was excellent. Latent class analysis of triazole-naive patients identified a nondiseased group and 3 disease classes: class 1 (n = 49, 37.7%) represented patients with or without positive RT-PCR but no immunologic response toA fumigatusand negative GM (nondiseased); class 2 (n = 23, 17.7%) represented patients with positive RT-PCR, elevated total and specificA fumigatusIgE/IgG, and positive GM (serologic allergic bronchopulmonary aspergillosis); class 3 (n = 19, 14.6%) represented patients with or without positive RT-PCR, elevatedA fumigatusIgE (not IgG), and negative GM (Aspergillussensitized); and class 4 (n = 39, 30%) represented patients with positive RT-PCR, elevatedA fumigatusIgG (not IgE), and positive GM (Aspergillusbronchitis). Conclusions Three distinct classes of aspergillosis in CF were identified by latent class analysis by using serologic, RT-PCR, and GM data. This novel classification will facilitate improved phenotyping, pathogenesis studies, and management evaluations.
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doi10.1016/j.jaci.2013.04.007
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date2013-09-01