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Aspergillus Colonisation vs CPA — SCE Infectious Diseases MCQ

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HardFungal InfectionsAspergillus Colonisation vs CPASCE Infectious Diseases

Aspergillus is cultured once from sputum in a stable bronchiectasis patient without chronic symptoms, cavitation or radiological progression and with non-elevated Aspergillus IgG. What is the best interpretation?

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Correct answer: D — Colonisation is more likely than chronic pulmonary aspergillosis; monitor clinically rather than diagnosing CPA from culture alone

The best answer is “Colonisation is more likely than chronic pulmonary aspergillosis; monitor clinically rather than diagnosing CPA from culture alone”. CPA requires a chronic compatible syndrome with characteristic imaging and supporting microbiology or serology; culture alone lacks specificity. “Diagnose invasive aspergillosis and start intravenous therapy” does not match the decisive clinical feature or cited guidance. “Start itraconazole because any sputum isolate proves CPA” does not match the decisive clinical feature or cited guidance. “Diagnose CPA regardless of imaging and symptoms” does not match the decisive clinical feature or cited guidance. “Start voriconazole solely because bronchiectasis is present” does not match the decisive clinical feature or cited guidance.

Reference: ERS/ESCMID chronic pulmonary aspergillosis guideline: https://pubmed.ncbi.nlm.nih.gov/26699723/