Chronic pulmonary aspergillosis (CPA) affects about 3 million people per year and has a poor prognosis, with mortality rates ranging from 7% to 52%. It is a fungal infection usually associated with previous lung diseases, such as tuberculosis. Diagnosis is challenging and requires persistent respiratory symptoms, compatible radiological abnormalities, and laboratory evidence of fungal infection. One key laboratory criterion is serology for anti-Aspergillus IgG. Thus, this study aimed to assess the positivity rate of serologic tests used in the diagnosis of Aspergillus spp. infection in patients seen at a hospital in southern Brazil. Retrospective study of patients seen between January 2022 and June 2025 at a hospital in southern Brazil who underwent serology for anti-Aspergillus IgG. Clinical and epidemiological data of seropositive cases and results of respiratory cultures were obtained from electronic medical records and the Mycology Laboratory database. Serology was performed using an ELISA (enzyme-linked immunosorbent assay). Over the 3.5-year period, 342 patients were investigated with serology for CPA. Of these, 19 (5.5%) had positive results and 7 (2%) had borderline results, classified as intermediate according to the kit manufacturer. Among these 26 patients (positive + intermediate), only 7 had positive cultures for Aspergillus spp., 4 from section Fumigati and 3 from section Nigri. The mean age of patients was 55 years, and the main associated conditions were tuberculosis (46%), chronic obstructive pulmonary disease (38%), bronchiectasis (15%), HIV infection (15%), and asthma (11%). Three patients died, but a direct relationship with CPA could not be established. Thus, although Aspergillus isolation occurred in only 27% of cases, serology was positive or borderline in a significant portion of the sample, underscoring its value as a sensitive and accessible diagnostic method. Our findings reinforce the importance of ELISA-based anti-Aspergillus IgG serology as an essential tool in the diagnosis of aspergillosis, showing positive results even in patients without fungal isolation from respiratory samples. Its implementation in routine laboratory practice is crucial for mycological confirmation.
Medeiros et al. (Sun,) studied this question.