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Comparative Study
. 2019 Mar;62(3):230-236.
doi: 10.1111/myc.12881. Epub 2019 Jan 15.

Point-of-care diagnosis of invasive aspergillosis in non-neutropenic patients: Aspergillus Galactomannan Lateral Flow Assay versus Aspergillus-specific Lateral Flow Device test in bronchoalveolar lavage

Jeffrey D Jenks  1 , Sanjay R Mehta  1 , Randy Taplitz  1 , Saima Aslam  1 , Sharon L Reed  1   2 , Martin Hoenigl  1
Affiliations
Comparative Study

Point-of-care diagnosis of invasive aspergillosis in non-neutropenic patients: Aspergillus Galactomannan Lateral Flow Assay versus Aspergillus-specific Lateral Flow Device test in bronchoalveolar lavage

Jeffrey D Jenks et al. Mycoses. 2019 Mar.

Abstract

Background: We compared new Aspergillus Galactomannan Lateral Flow Assay with the newly formatted Aspergillus-specific Lateral Flow device tests for the diagnosis of invasive pulmonary aspergillosis (IPA) in non-neutropenic patients.

Methods: We performed both tests in 82 bronchoalveolar lavage fluid samples from 82 patients at risk for IPA but without underlying haematologic malignancy. Samples were collected between September 2016 and September 2018 at the University of California San Diego, United States. IPA was classified following two published consensus criteria.

Results: Classification of cases varied widely between the two consensus criteria. When using criteria established for the intensive care unit, 26/82 patients (32%) met criteria for proven or putative IPA. Both point-of-care assays showed sensitivities ranging between 58% and 69%, with specificities between 68% and 75%. Sensitivity increased up to 81% when both tests were combined.

Conclusion: The study outlines the need for updated, unified and more broadly applicable consensus definitions for classifying IPA in non-neutropenic patients, a work that is currently in progress. Both point-of-care tests showed comparable performance, with sensitivities and specificities in the 60%-70% range when used alone and increasing to 80% when used in combination. The new point-of-care tests may serve a role at the bedside in those with clinical suspicion of IPA.

Keywords: BAL; HIV; Aspergillus Galactomannan Lateral Flow Assay (LFA); Aspergillus-specific Lateral Flow Device tests (LFD); autoimmune diseases; galactomannan; intensive care; respiratory diseases; solid organ transplantation.

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Conflict of interest statement

Potential conflicts of interest

M. Hoenigl received research grants from Gilead.

R. Taplitz served as a consultant for Merck.

All other authors no conflict.

Figures

Figure 1:
Figure 1:
Categorization of IPA based on EORTC/MSG modified Blot Criteria. Green bubbles indicate classification agreement of both criteria, while yellow and blue bubbles outline cases where classification differed between criteria.
Figure 2:
Figure 2:
Left: Results with the CE-marked Aspergillus-specific Lateral Flow Device Test lateral-flow device test ranging from negative (–) to strong positive (+++). Right: Results with the CE-marked Aspergillus Galactomannan Lateral Flow Assay, ranging from negative (0) to strong positive (4).
See this image and copyright information in PMC

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