ECCMID 曲霉菌指南简介 慢性肺曲霉菌病感染
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•曲霉肉芽肿病
Aspergillus nodule(s)
•慢性空腔曲霉菌病/复杂曲霉球病
Chronic Cavitary Pulmonary Aspergillosis/Complex Aspergilloma (CCPA)
•慢性纤维化肺曲霉菌病
Chronic Fibrosing Pulmonary Aspergillosis (CFPA)
干预手段 Intervention
直接镜检发现 菌丝
Direct microscopy for
hyphae
组织病理
Histology
（气道分泌物 ）真菌培养
Fungal culture （ respiratory secretion）
（经皮肺穿刺 ）真菌培养
Fungal culture (transparietal
慢性纤维化肺曲霉菌病
Chronic fibrosing pulmonary aspergillosis (CFPA)
不同类型的慢性曲霉菌病
Different patterns of CPA
曲霉菌肉芽肿Aspergillus nodule(s)
单发曲霉球 Single/simple aspergilloma
慢性肺曲霉菌病-抗体检
测
Asp患e者r人gi群llus antibo目d的y diagnosis干预手段
Population
of CIPnAtention
Intervention
在非免疫抑制 患者中伴有空 腔/结节肺浸
Cavi润tary or
nodular
pulmonary infiltrate in Nonimmunocompro mised patients
细菌培养平板 的敏感性叫真 菌平板的敏感
性较低。
PCR的敏感性 较培养高
慢性肺曲霉菌病-抗原检测
Antigen diagnosis of CPA
患者人群 Population
在非免疫抑制 患者中伴有空 腔/结节肺浸
Cavi润tary or
nodular pulmonary infiltrate in Nonimmunocompro mised patients
文献 Reference
备注 Comment
Uffredi, 2003
Denning, 2003;
Horvath, 1994
慢性曲霉菌病 中病理能够将 半侵袭性曲霉 菌病（SAIA ）/慢性坏死 性肺曲霉菌病 与慢性空腔性 肺曲霉菌病区
分开来。
镜检阳性是一 个感染的强指
证。
Denning, 2013; Duddy, 2012 Horvath, 1994
慢性空腔性肺曲霉菌病 Chronic cavitary pulmonary aspergillosis (CCPA) esent by David Denning CCMID 10th May 2015 in Barcelona
慢性纤维化肺曲霉菌病
Chronic fibrosing pulmonary aspergillosis (CFPA)
诊断或排除慢 性肺曲霉菌病
Diagnosis Or
exclusion of CPA
曲霉抗体IgG
Aspergillus IgG antibody
曲霉沉淀素
Aspergillus precipitins
曲霉抗体IgM
Aspergillus IgM antibody
哮喘/变态反 应性肺曲霉菌 病（ABPA） /囊性纤维化 Asthm(aC/FAB) PA/C
目的 Intention
诊断或排除慢 性肺曲霉菌病
Diagnosis Or
exclusion of CPA
干预手段 Intervention
肺泡灌洗液抗 Antigen原（BAL）
血清学抗原检 Antigen测（Serum
）
痰培抗原检测
Antigen（ Sputum）
SoR QoE
文献 Reference
养或PCR方法检测曲霉样性
Histological or microbiological or immunologic evidence of Aspergillus infection (e.g.histological evidence of
排除Asp：aenrtgiiglelnu;s-ploiskietihvyephIageG
exte+nsive fibrosis or nodule)
2.2 患者的临床表现和影像学证据至少存在3个月以上时间[注意半侵袭性/慢性坏死性肺曲霉病的疾病疗
程相对CPA较短，可逐渐演化成慢性肺曲霉病]
Clinical or radiological evidence of at least 3 months disease (sometimes inferred) [Note shorter durations of disease may
Only for internal learning or discussion , forbidden for any other purpose
慢性肺曲霉菌病-疾病分类
nic Pulmonary Aspergillosis - subsets
•单发曲霉球
Simple/single Aspergilloma
•亚急性侵袭性/半侵袭性/慢性坏死性肺曲霉菌病
Subacute invasive(SIA)/Semi-Invasive/Chronic Necrotizing Pulmonary Aspergillosis (CNPA)
esent CCMID
by 10th
DMaavyi2d01D5einnnBianrgc注elo：na真菌球（曲霉球）可出现在以上除曲霉菌肉芽肿之外的任意一种情况中
F
resent by David Denning CCMID 10th May 2015 in Barcelona
曲霉抗体IgA
Aspergillus IgA antibody
曲霉抗体IgE
Aspergillus IgE antibody
SoR QoE
ห้องสมุดไป่ตู้
文献 Reference
EFISGESCMID Fungal Infectious Study Group
European Society of Clinical Microbiology and Infection Diseases
2014 ESCMID曲霉菌病治疗指南-慢性 14 ESCMID Aspergillus Guid肺eli曲ne-霉Ch病ronic Pulmonary Aspergillosis
慢性曲霉菌病临床表现分类
l phenotypes of chronic Aspergillus spp diseases
单发曲霉球
Single/simple aspergilloma
曲霉菌肉芽 肿
Aspergillus nodule(s)
慢性空腔性肺曲霉 菌病
Chronic cavitary pulmonary aspergillosis (CCPA)
be seen in SIA/CNPA, w+hich becomes CPA because of its chronicity],
2.3 获得与曲霉菌感染相关的组织病理或微生物证据或免疫学证据（如：肺活检中组织病理发现曲霉样
菌丝或经皮肺穿刺培养阳性；肺泡灌洗液抗原强阳性；IgG抗体阳性/曲霉沉淀素阳性）呼吸道分泌物培
慢性坏死性/亚急性肺曲 霉菌病
Chronic necrotizing pulmonary aspergillosis (CNPA) or subacute
Invasive aspergillosis (SAI)
resent by David Denning CCMID 10th May 2015 in Barcelona
in lung biopsy or Aspergillus culture from a percutaneous cavity antibody/precipitins). Respiratory tract culture or PCR positive
aspiration; strongly positive BAL for Aspergillus is supportive.
resent by David Denning CCMID 10th May 2015 in Barcelona
慢性肺曲霉菌病-气道标本的诊断
Respiratory specimen diagnosis of CPA
患者人群 Population
在非免疫抑制 患者中伴有空 腔/结节肺浸
Cavi润tary or
对于特定地区或游历该地区患者需要排除组织胞浆菌，球孢子菌和副球孢子菌感染；以及排除肺放线菌 病。排除活动性细菌感染，包括分枝杆菌感染伴或不伴恶性肿瘤。分枝杆菌感染可能与真菌感染相似
Exclusion of histoplasmosis, coccidioidomycosis and paracoccidiodomycosis in endemic areas or those with pertinent travel history; actinomycosis. Active bacterial infection, including mycobacterial infection and/or malignancy may occur concurrently. Mycobacterial infections or malignancy may mimic CPA.
)
滨州医学院附属烟台海 港医院
急诊科 王功军
Present by David W.Denning [United Kingdom ECCMID 10th May 2015 in Barcelona
欧洲临床微生物与感染性疾病学会(ESCMID,European Society of Clinical Microbiology and Infectious Diseases)
aspiration)
（气道分泌物 ）曲霉菌PCR
Aspergillus PCR (respiratory
secretion)
细菌培养
Bacterial culture
resent by David Denning CCMID 10th May 2015 in Barcelona
SoR QoE
A II A II A III B II C II C IIt
Any direct or indirect microbiological evidence of Aspergillus infection (see below). ,
或：
2.1 影像学特征持续表现为慢性肺曲霉菌病（包括空腔，胸膜增厚，严重的纤维化或肉芽肿）
Radiological features consistent with chronic pulmonary aspergillosis (including cavity(ies), pleural thickening,
慢性肺曲霉菌病-诊断标准
Pulmonary Aspergillosis – Diagnostic criteria
需要满足以下条件：
1.1 CT影像学表现为肺部真菌球 或 胸腔内空腔，或支 气管扩张
Characteristic CT appearance of a fungus ball in +a pulmonary or p1le.u2ra任l c何av与ity曲, o霉r 菌dil感ate染d b相ro关nch的us,直接或间接的微生物证据
备注 Comment
B II C II No
Izumikawa ,
2012 Izumikawa,2
012;
Kono,2013;
Shin,2014
血清和肺泡灌 洗液的抗原检 测已经建立研 究，但痰液的 抗原尚未涉及
data
resent by David Denning CCMID 10th May 2015 in Barcelona
nodular pulmonary infiltrate in Nonimmunocompro mised patients
目的 Intention
诊断或排除慢 性肺曲霉菌病
Diagnosis Or
exclusion of CPA
确诊或排除其 他病原体
To document or
Exclude other pathogens
Aspergillus nodule(s)
•慢性空腔曲霉菌病/复杂曲霉球病
Chronic Cavitary Pulmonary Aspergillosis/Complex Aspergilloma (CCPA)
•慢性纤维化肺曲霉菌病
Chronic Fibrosing Pulmonary Aspergillosis (CFPA)
干预手段 Intervention
直接镜检发现 菌丝
Direct microscopy for
hyphae
组织病理
Histology
（气道分泌物 ）真菌培养
Fungal culture （ respiratory secretion）
（经皮肺穿刺 ）真菌培养
Fungal culture (transparietal
慢性纤维化肺曲霉菌病
Chronic fibrosing pulmonary aspergillosis (CFPA)
不同类型的慢性曲霉菌病
Different patterns of CPA
曲霉菌肉芽肿Aspergillus nodule(s)
单发曲霉球 Single/simple aspergilloma
慢性肺曲霉菌病-抗体检
测
Asp患e者r人gi群llus antibo目d的y diagnosis干预手段
Population
of CIPnAtention
Intervention
在非免疫抑制 患者中伴有空 腔/结节肺浸
Cavi润tary or
nodular
pulmonary infiltrate in Nonimmunocompro mised patients
细菌培养平板 的敏感性叫真 菌平板的敏感
性较低。
PCR的敏感性 较培养高
慢性肺曲霉菌病-抗原检测
Antigen diagnosis of CPA
患者人群 Population
在非免疫抑制 患者中伴有空 腔/结节肺浸
Cavi润tary or
nodular pulmonary infiltrate in Nonimmunocompro mised patients
文献 Reference
备注 Comment
Uffredi, 2003
Denning, 2003;
Horvath, 1994
慢性曲霉菌病 中病理能够将 半侵袭性曲霉 菌病（SAIA ）/慢性坏死 性肺曲霉菌病 与慢性空腔性 肺曲霉菌病区
分开来。
镜检阳性是一 个感染的强指
证。
Denning, 2013; Duddy, 2012 Horvath, 1994
慢性空腔性肺曲霉菌病 Chronic cavitary pulmonary aspergillosis (CCPA) esent by David Denning CCMID 10th May 2015 in Barcelona
慢性纤维化肺曲霉菌病
Chronic fibrosing pulmonary aspergillosis (CFPA)
诊断或排除慢 性肺曲霉菌病
Diagnosis Or
exclusion of CPA
曲霉抗体IgG
Aspergillus IgG antibody
曲霉沉淀素
Aspergillus precipitins
曲霉抗体IgM
Aspergillus IgM antibody
哮喘/变态反 应性肺曲霉菌 病（ABPA） /囊性纤维化 Asthm(aC/FAB) PA/C
目的 Intention
诊断或排除慢 性肺曲霉菌病
Diagnosis Or
exclusion of CPA
干预手段 Intervention
肺泡灌洗液抗 Antigen原（BAL）
血清学抗原检 Antigen测（Serum
）
痰培抗原检测
Antigen（ Sputum）
SoR QoE
文献 Reference
养或PCR方法检测曲霉样性
Histological or microbiological or immunologic evidence of Aspergillus infection (e.g.histological evidence of
排除Asp：aenrtgiiglelnu;s-ploiskietihvyephIageG
exte+nsive fibrosis or nodule)
2.2 患者的临床表现和影像学证据至少存在3个月以上时间[注意半侵袭性/慢性坏死性肺曲霉病的疾病疗
程相对CPA较短，可逐渐演化成慢性肺曲霉病]
Clinical or radiological evidence of at least 3 months disease (sometimes inferred) [Note shorter durations of disease may
Only for internal learning or discussion , forbidden for any other purpose
慢性肺曲霉菌病-疾病分类
nic Pulmonary Aspergillosis - subsets
•单发曲霉球
Simple/single Aspergilloma
•亚急性侵袭性/半侵袭性/慢性坏死性肺曲霉菌病
Subacute invasive(SIA)/Semi-Invasive/Chronic Necrotizing Pulmonary Aspergillosis (CNPA)
esent CCMID
by 10th
DMaavyi2d01D5einnnBianrgc注elo：na真菌球（曲霉球）可出现在以上除曲霉菌肉芽肿之外的任意一种情况中
F
resent by David Denning CCMID 10th May 2015 in Barcelona
曲霉抗体IgA
Aspergillus IgA antibody
曲霉抗体IgE
Aspergillus IgE antibody
SoR QoE
ห้องสมุดไป่ตู้
文献 Reference
EFISGESCMID Fungal Infectious Study Group
European Society of Clinical Microbiology and Infection Diseases
2014 ESCMID曲霉菌病治疗指南-慢性 14 ESCMID Aspergillus Guid肺eli曲ne-霉Ch病ronic Pulmonary Aspergillosis
慢性曲霉菌病临床表现分类
l phenotypes of chronic Aspergillus spp diseases
单发曲霉球
Single/simple aspergilloma
曲霉菌肉芽 肿
Aspergillus nodule(s)
慢性空腔性肺曲霉 菌病
Chronic cavitary pulmonary aspergillosis (CCPA)
be seen in SIA/CNPA, w+hich becomes CPA because of its chronicity],
2.3 获得与曲霉菌感染相关的组织病理或微生物证据或免疫学证据（如：肺活检中组织病理发现曲霉样
菌丝或经皮肺穿刺培养阳性；肺泡灌洗液抗原强阳性；IgG抗体阳性/曲霉沉淀素阳性）呼吸道分泌物培
慢性坏死性/亚急性肺曲 霉菌病
Chronic necrotizing pulmonary aspergillosis (CNPA) or subacute
Invasive aspergillosis (SAI)
resent by David Denning CCMID 10th May 2015 in Barcelona
in lung biopsy or Aspergillus culture from a percutaneous cavity antibody/precipitins). Respiratory tract culture or PCR positive
aspiration; strongly positive BAL for Aspergillus is supportive.
resent by David Denning CCMID 10th May 2015 in Barcelona
慢性肺曲霉菌病-气道标本的诊断
Respiratory specimen diagnosis of CPA
患者人群 Population
在非免疫抑制 患者中伴有空 腔/结节肺浸
Cavi润tary or
对于特定地区或游历该地区患者需要排除组织胞浆菌，球孢子菌和副球孢子菌感染；以及排除肺放线菌 病。排除活动性细菌感染，包括分枝杆菌感染伴或不伴恶性肿瘤。分枝杆菌感染可能与真菌感染相似
Exclusion of histoplasmosis, coccidioidomycosis and paracoccidiodomycosis in endemic areas or those with pertinent travel history; actinomycosis. Active bacterial infection, including mycobacterial infection and/or malignancy may occur concurrently. Mycobacterial infections or malignancy may mimic CPA.
)
滨州医学院附属烟台海 港医院
急诊科 王功军
Present by David W.Denning [United Kingdom ECCMID 10th May 2015 in Barcelona
欧洲临床微生物与感染性疾病学会(ESCMID,European Society of Clinical Microbiology and Infectious Diseases)
aspiration)
（气道分泌物 ）曲霉菌PCR
Aspergillus PCR (respiratory
secretion)
细菌培养
Bacterial culture
resent by David Denning CCMID 10th May 2015 in Barcelona
SoR QoE
A II A II A III B II C II C IIt
Any direct or indirect microbiological evidence of Aspergillus infection (see below). ,
或：
2.1 影像学特征持续表现为慢性肺曲霉菌病（包括空腔，胸膜增厚，严重的纤维化或肉芽肿）
Radiological features consistent with chronic pulmonary aspergillosis (including cavity(ies), pleural thickening,
慢性肺曲霉菌病-诊断标准
Pulmonary Aspergillosis – Diagnostic criteria
需要满足以下条件：
1.1 CT影像学表现为肺部真菌球 或 胸腔内空腔，或支 气管扩张
Characteristic CT appearance of a fungus ball in +a pulmonary or p1le.u2ra任l c何av与ity曲, o霉r 菌dil感ate染d b相ro关nch的us,直接或间接的微生物证据
备注 Comment
B II C II No
Izumikawa ,
2012 Izumikawa,2
012;
Kono,2013;
Shin,2014
血清和肺泡灌 洗液的抗原检 测已经建立研 究，但痰液的 抗原尚未涉及
data
resent by David Denning CCMID 10th May 2015 in Barcelona
nodular pulmonary infiltrate in Nonimmunocompro mised patients
目的 Intention
诊断或排除慢 性肺曲霉菌病
Diagnosis Or
exclusion of CPA
确诊或排除其 他病原体
To document or
Exclude other pathogens