Publication date: Available online 15 September 2017
Source:Revue des Maladies Respiratoires
Author(s): L. Lachaud, J.P. Gangneux
Les parasitoses pulmonaires sont des pathologies rares, alors que les mycoses pulmonaires ne cessent d'augmenter. La diversité des tableaux cliniques oblige à mettre en œuvre des examens biologiques pour affirmer le diagnostic. L'examen direct d'un échantillon pulmonaire et la recherche d'anticorps sont la base du diagnostic parasitologique. Pour les mycoses, la panoplie des examens biologiques est vaste. L'examen mycologique standard permet la recherche sans a priori de tous les champignons à l'exception de Pneumocystis jirovecii. Il a une excellente spécificité mais manque de sensibilité. La recherche d'anticorps, d'antigènes voire d'acides nucléiques complète les outils diagnostiques. En ce qui concerne les aspergilloses, elles constituent un vaste ensemble nosologique de pronostic variable. Le choix des examens biologiques spécifiques dépendra de la forme clinique et du terrain du patient. La recherche de l'antigène galactomannane est performante, une nouvelle technique « Lateral Flow Device » semble très prometteuse. La détection d'anticorps est aussi informative et les techniques utilisées variées. Une bonne connaissance des performances et limites des techniques permet une prescription ciblée. L'utilisation de la PCR pour le diagnostic des mycoses pulmonaires a des indications restreintes. Le dialogue clinico-biologique est primordial pour le choix et l'interprétation des examens biologiques en cas de parasitoses ou de mycoses pulmonaires.Pulmonary parasitic diseases are rare whereas pulmonary fungal infections are increasing. The diversity of clinical presentations requires laboratory tests to confirm the diagnosis. Direct examination of lung samples and antibody detection are the basis of parasitological diagnosis. With regard to mycoses, the range of biological tests is broader. The conventional mycological examination allows identification of any type of fungus except Pneumocystis jirovecii. Its specificity is excellent but it lacks sensitivity. Detection of antibodies, antigens or nucleic acid complements the diagnostic tools. With regard to aspergillosis, there is a broad nosological set with variable prognosis. The choice of appropriate laboratory procedures depends on the clinical presentation and patient risk factors. The search for galactomannan antigen is effective and a new technique, "Lateral Flow Device", seems very promising. The detection of antibodies is also informative but various techniques are used. A good knowledge of the performance and limitations of these techniques allows targeted prescription. The use of PCR for the diagnosis of pulmonary fungal infections has limited indications. Biological and clinical co-operation is essential for the choice and interpretation of laboratory tests for parasitic or fungal pulmonary disease.
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