Am. J. Respir. Crit. Care Med., Vol 151, No. 1, Jan 1995, 199-204.
Serologic monitoring of disease and treatment in a patient with pulmonary aspergilloma
JF Tomee, TS van der Werf, JP Latge, GH Koeter, AE Dubois and HF Kauffman
Department of Allergology, University Hospital Groningen, The Netherlands.
Disease progression and efficacy of fungistatic treatment in pulmonary
aspergilloma (PA) are difficult to monitor. The usefulness of chest
tomography, IgG-ELISA serology, double immunodiffusion, and IgG-
immunoblotting 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
recrudescence of clinical symptoms, whereas a decrease after treatment
paralleled clinical improvement. IgG-binding to a 32-kD serine protease and
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 fungal
growth became well advanced, when a sharp rise was seen. Responses to all
antigens rapidly diminished after the start of successful treatment with
itraconazole. Serology may be a useful adjunct in the monitoring of disease
progression and the efficacy of itraconazole treatment in patients with PA.
IgG-binding to individual fungal proteins shows subtle differences in
kinetics. Immunologic responses to fungal proteases 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.
