Comparative analysis of Galactomannan Lateral Flow Assay, Galactomannan Enzyme Immunoassay and BAL culture for Diagnosis of COVID-19 associated pulmonary aspergillosis

Mycoses. 2022 Aug 18. doi: 10.1111/myc.13518. Online ahead of print.

ABSTRACT

BACKGROUND: Galactomannan Enzyme Immunoassay (GM-EIA) is proved to be a cornerstone in the diagnosis of COVID-19-associated pulmonary aspergillosis (CAPA), its use is limited in middle and low-income countries, where the application of simple and rapid test, including Galactomannan Lateral Flow Assay (GM-LFA), is highly appreciated. Despite such merits, limited studies directly compared GM-LFA to GM-EIA. Herein we compared the diagnostic features of GM-LFA, GM-EIA, and BAL culture for CAPA diagnosis in Iran, a developing country.

MATERIALS/METHODS: Diagnostic performance of GM-LFA and GM-EIA in BAL (GM indexes ≥ 1) and serum (GM indexes > 0.5), i.e., sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) and areas under the curve (AUC), were evaluated using BAL (n=105) and serum (n=101) samples from mechanically ventilated COVID-19 patients in intensive care units. Patients were classified based on the presence of host factors, radiological findings, and mycological evidences according to 2020 ECMM/ISHAM consensus criteria for CAPA diagnosis.

RESULTS: The Aspergillus GM-LFA for serum and BAL samples showed a sensitivity of 56.3% and 60.6%, specificity of 94.2% and 88.9%, PPV of 81.8% and 71.4%, NPV of 82.3% and 83.1%, when compared to BAL culture, respectively. GM-EIA showed sensitivities of 46.9% and 54.5%, specificities of 100% and 91.7%, PPVs of 100% and 75%, NPVs of 80.2% and 81.5% for serum and BAL samples, respectively.

CONCLUSION: Our study found GM-LFA as a reliable simple and rapid diagnostic tool, which could circumvent the shortcomings of culture and GM-EIA and be pivotal in timely initiation of antifungal treatment.

PMID:35979737 | DOI:10.1111/myc.13518

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