Comparison of Aspergillus-specific antibody cut-offs for the diagnosis of aspergillosis

Abstract

BackgroundAspergillus diseases are frequently encountered in patients who are immunocompromised. Without a prompt diagnosis, the clinical consequences may be lethal. Aspergillus-specific antibodies have been widely used to facilitate the diagnosis of Aspergillus diseases. To date, universally standardized cut-off values have not been established. This study aimed to investigate the cut-off values of Aspergillus-specific antibodies and perform a narrative review to depict the geographic differences in the Taiwanese population.MethodsWe analyzed enrolled 118 healthy controls, 29 patients with invasive aspergillosis (IA), chronic pulmonary aspergillosis (CPA), and allergic bronchopulmonary aspergillosis (ABPA) and 99 with disease control, who were tested for Aspergillus fumigatus and Aspergillus niger-specific IgG and IgE using ImmunoCAP. 99 participants not fulfilling the diagnosis of IA, CPA, and ABPA were enrolled in the disease control group. The duration of retrieval of medical records from June 2018 to September 2021. Optimal cut-offs and association were determined using receiver operating characteristic curve (ROC) analysis.ResultsWe found that patients with CPA had the highest A. fumigatus-specific IgG levels while patients with ABPA had the highest A. fumigatus-specific IgE, and A. niger-specific IgG and IgE levels. In patients with CPA and ABPA, the optimal cut-offs of A. fumigatus-specific IgG and A. niger-specific IgG levels were 41.6, 40.8, 38.1, and 69.9 mgA/l, respectively. Geographic differences in the cut-off values of A. fumigatus-specific IgG were also noted. Specifically, the levels were different in eco-climatic zones.ConclusionWe identified the optimal cut-offs of Aspergillus-specific antibodies to facilitate a precise diagnosis of aspergillosis. The observed geographic differences of the antibody levels suggest that an eco-climatic-specific reference is needed to facilitate a prompt and accurate diagnosis of aspergillosis.

Comparison of diagnostic efficiency of detecting IgG and IgE with immunoassay method in diagnosing ABPA: a meta-analysis

“…After the initial search, we found 3383 articles (1083 for PubMed and 2288 for Embase, and 12 for unpublished data). After screening the abstracts and titles and evaluating the eligibility for research based on the inclusion and exclusion criteria, eight manuscripts were included in our study, with 1127 subjects and 215 for IgE and IgG [ 5 , 9 , 20 – 25 ], respectively. Due to the differences in various dimensions of included studies, for example, the exact method for immunoassay, the different cut-off values, and different antigens, the studies were heterogeneous.…”

“…Both criteria have been widely used to diagnose ABPA [ 8 ]. The serological examination is of great help in diagnosing and eliminating possible ABPA [ 5 , 9 ]. The major pathological condition of ABPA is to measure the level of Aspergillus -specific immunoglobulin E (IgE) and immunoglobulin G (IgG) antibodies or precipitated antibodies to detect type I and III allergic reactions [ 5 ].…”

“…As mentioned above, the detection of A. fumigatus specific IgG and IgE are pivotal for diagnosing ABPA because they reflect type I and III allergic reactions to Aspergillus species [ 2 , 5 ]. There have been studies into the sensitivity and specificity of immunoassay methods detecting IgE and IgG [ 9 , 11 ]. However, there are differences in the conclusions of these studies.…”

Allergic bronchopulmonary aspergillosis in India

“…The optimal cut-off for A. fumigatus-specific IgG varies between different ethnicities. 62 In the Japanese population, the cut-off value for A. fumigatus-specific IgG in diagnosing ABPA is 60 mgA/L using the Phadia fluorescent enzyme immunoassay platform. 63 In contrast, we found a cut-off value of 27 mgA/L in India.…”

Chronic pulmonary Aspergillosis in a patient with poorly controlled diabetes: A case report and literatures review

“…T A B L E 1Abbreviations: AFS, acid-fast stain; BAL, bronchoalveolar lavage; CMV, cytomegalovirus; GM, galactomannan; NAA, nucleic acid amplification; PCR, polymerase chain reaction; QPCR, quantitative polymerase chain reaction; TB, tuberculosis.a Referenced from Zhou et al 12 bReferenced from Hsiao et al13 fumigatus and…”