Comparison of six Aspergillus-specific IgG assays for the diagnosis of chronic pulmonary aspergillosis (CPA)

Page, Iain; Richardson, Malcolm; Denning, David W.

doi:10.1016/j.jinf.2015.11.003

Cited by 117 publications

(181 citation statements)

References 30 publications

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“…It discriminates between infection and colonization with a positive predictive value of up to 100% [57]. Several commercial Aspergillus -specific IgG assays are available, but they show differences in sensitivity and specificity [58]. This is even more problematic when an in-house assay or Aspergillus precipitins are used.…”

Section: Current Standardized Management Approachmentioning

confidence: 99%

“…The latter is a gel-based immunodiffusion method used for decades to test patients' serum for the presence of precipitating antibodies to Aspergillus [59]. Although precipitin testing (beside Aspergillus -specific IgG antibodies) is also recommended by the novel ESCMID/ERS guidelines, more recent evidence indicates a poor performance with a sensitivity of 59% and a specificity of 100% [58]. Furthermore, this manual technique is time consuming, provides subjective results, and is difficult to reproduce [58,60,61].…”

Section: Current Standardized Management Approachmentioning

confidence: 99%

“…Although precipitin testing (beside Aspergillus -specific IgG antibodies) is also recommended by the novel ESCMID/ERS guidelines, more recent evidence indicates a poor performance with a sensitivity of 59% and a specificity of 100% [58]. Furthermore, this manual technique is time consuming, provides subjective results, and is difficult to reproduce [58,60,61]. Recently, Page et al [58] compared the diagnostic performance of six Aspergillus -specific IgG antibody assays in a large cohort of CPA patients.…”

Section: Current Standardized Management Approachmentioning

confidence: 99%

“…Furthermore, this manual technique is time consuming, provides subjective results, and is difficult to reproduce [58,60,61]. Recently, Page et al [58] compared the diagnostic performance of six Aspergillus -specific IgG antibody assays in a large cohort of CPA patients. The IMMULITE (Siemens Healthcare Diagnostics, Tarrytown, N.Y., USA; cutoff 10 mg/l; 96% sensitivity, 98% specificity) and the ImmunoCAP (Phadia AB, Uppsala, Sweden; cutoff 20 mg/l; 96% sensitivity, 98% specificity) assays performed statistically superiorly to the other assays tested.…”

Section: Current Standardized Management Approachmentioning

confidence: 99%

“…Identification of biomarkers guiding the decision when to initiate NTM-PD therapy and allowing the prediction of treatment failure or success early in the course of therapy would be useful, but such biomarkers have not been investigated so far either. For CPA, Aspergillus - specific IgG antibody has been shown to differentiate between colonization and infection with a sensitivity of 96% and a specificity of 98% [58]. Antifungal prophylaxis in patients at high risk for CPA may prevent disease development; however, host factors identifying patients at high risk are unknown.…”

Section: Future Perspective: Personalized Medicine To Improve Clinicamentioning

confidence: 99%

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Personalized Medicine for Chronic Respiratory Infectious Diseases: Tuberculosis, Nontuberculous Mycobacterial Pulmonary Diseases, and Chronic Pulmonary Aspergillosis

et al. 2016

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Chronic respiratory infectious diseases are causing high rates of morbidity and mortality worldwide. Tuberculosis, a major cause of chronic pulmonary infection, is currently responsible for approximately 1.5 million deaths per year. Although important advances in the fight against tuberculosis have been made, the progress towards eradication of this disease is being challenged by the dramatic increase in multidrug-resistant bacilli. Nontuberculous mycobacteria causing pulmonary disease and chronic pulmonary aspergillosis are emerging infectious diseases. In contrast to other infectious diseases, chronic respiratory infections share the trait of having highly variable treatment outcomes despite longstanding antimicrobial therapy. Recent scientific progress indicates that medicine is presently at a transition stage from programmatic to personalized management. We explain current state-of-the-art management concepts of chronic pulmonary infectious diseases as well as the underlying methods for therapeutic decisions and their implications for personalized medicine. Furthermore, we describe promising biomarkers and techniques with the potential to serve future individual treatment concepts in this field of difficult-to-treat patients. These include candidate markers to improve individual risk assessment for disease development, the design of tailor-made drug therapy regimens, and individualized biomarker-guided therapy duration to achieve relapse-free cure. In addition, the use of therapeutic drug monitoring to reach optimal drug dosing with the smallest rate of adverse events as well as candidate agents for future host-directed therapies are described. Taken together, personalized medicine will provide opportunities to substantially improve the management and treatment outcome of difficult-to-treat patients with chronic respiratory infections.

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Section: Current Standardized Management Approachmentioning

confidence: 99%

Section: Current Standardized Management Approachmentioning

confidence: 99%

Section: Current Standardized Management Approachmentioning

confidence: 99%

Section: Current Standardized Management Approachmentioning

confidence: 99%

Section: Future Perspective: Personalized Medicine To Improve Clinicamentioning

confidence: 99%

See 3 more Smart Citations

Personalized Medicine for Chronic Respiratory Infectious Diseases: Tuberculosis, Nontuberculous Mycobacterial Pulmonary Diseases, and Chronic Pulmonary Aspergillosis

et al. 2016

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Immunoproteomics of Aspergillus for the development of biomarkers and immunotherapies

Kniemeyer

Ebel²,

Krüger

et al. 2016

Proteomics Clinical Apps

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Filamentous fungi of the genus Aspergillus play significant roles as pathogens causing superficial and invasive infections as well as allergic reactions in humans. Particularly invasive mycoses caused by Aspergillus species are characterized by high mortality rates due to difficult diagnosis and insufficient antifungal therapy. The application of immunoproteomic approaches has a great potential to identify new targets for the diagnosis, therapy, and vaccine development of diseases caused by Aspergillus species. Serological proteome analyses (SERPA) that combine 2D electrophoresis with Western blotting are still one of the most popular techniques for the identification of antigenic proteins. However, recently a growing number of approaches have been developed to identify proteins, which either provoke an antibody response or which represent targets of T-cell immunity in patients with allergy or fungal infections. Here, we review advances in the studies of immune responses against pathogenic Aspergilli as well as the current status of diagnosis and immunotherapy of Aspergillus infections.

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Aspergillus-Nachweis im Atemwegsmaterial

2017

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Fungi of the genus Aspergillus are ubiquitously present. Even though humans inhale Aspergillus spores daily under natural conditions, Aspergillus-associated pulmonary diseases only occur under special circumstances. Whether an Aspergillus-associated disease develops and which type of Aspergillus-associated disease develops depends on the constitution of the host. The spectrum of Aspergillus-associated pulmonary diseases ranges from allergic diseases, such as hypersensitivity pneumonitis to allergic infectious diseases, such as allergic bronchopulmonary aspergillosis (ABPA) and bronchocentric granulomatosis (BG) to infectious diseases, such as invasive (IA) or semi-invasive aspergillosis (SIA) and chronic pulmonary aspergillosis (CPA). Identification of Aspergillus spp. from sputum or bronchopulmonary secretions is not sufficient for a definitive diagnosis of Aspergillus-associated infections. The gold standard is the identification of Aspergillus spp. from lung tissue by culture or by histopathological methods; however, in clinical practice the decision to initiate antifungal therapy is more often based on immunological methods, such as the detection of Aspergillus-specific IgG antibodies from peripheral blood or galactomannan antigens from bronchoalveolar lavages. Acute IA or SIA infections have a high mortality and require immediate antifungal therapy. With rare exceptions CPA cannot be cured by medicinal therapy alone; however, active CPA can be brought into remission with antifungal therapy. Eradication of Aspergillus in CPA can as a rule only be successful using a combined antimycotic and surgical intervention.

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Comparison of six Aspergillus-specific IgG assays for the diagnosis of chronic pulmonary aspergillosis (CPA)

Abstract: ImmunoCAP and Immulite were statistically significantly superior to the other assays. Precipitins testing performed poorly. The currently accepted ImmunoCAP cut-off of 40 mg/L appears sub-optimal for CPA diagnosis and may require revision in this context.

Cited by 117 publications

References 30 publications

Personalized Medicine for Chronic Respiratory Infectious Diseases: Tuberculosis, Nontuberculous Mycobacterial Pulmonary Diseases, and Chronic Pulmonary Aspergillosis

Personalized Medicine for Chronic Respiratory Infectious Diseases: Tuberculosis, Nontuberculous Mycobacterial Pulmonary Diseases, and Chronic Pulmonary Aspergillosis

Immunoproteomics of Aspergillus for the development of biomarkers and immunotherapies

Aspergillus-Nachweis im Atemwegsmaterial

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