Evaluation and comparison of automated and manual ELISA for diagnosis of chronic pulmonary aspergillosis (CPA) in Indonesia

Setianingrum, Findra; Rozaliyani, Anna; Syam, Ridhawati; Adawiyah, Robiatul; Tugiran, Mulyati; Sari, Cut Yulia Indah; Burhan, Erlina; Wahyuningsih, Retno; Rautemaa‐Richardson, Riina; Denning, David W.

doi:10.1016/j.diagmicrobio.2020.115124

Cited by 15 publications

(19 citation statements)

References 21 publications

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“…The link with older age may be partially explained by the chronic development of CPA [3], but some comorbidities were also found; 10% of our patients had at least one comorbidity, mostly COPD or diabetes. Diabetes has been described as a significant association with CPA, as reported in several previous studies [16][17][18]. Diabetes is also considered a risk factor for developing a cavity during pulmonary TB and may be a risk factor for developing CPA [19][20][21].…”

Section: Discussionmentioning

confidence: 64%

“…This is similar to other studies, where CPA is most often reported mostly in middle-aged patients. In a previous study, age has been reported as a risk factor for poor outcomes in CPA TB patients [ 16 ]. The link with older age may be partially explained by the chronic development of CPA [ 3 ], but some comorbidities were also found; 10% of our patients had at least one comorbidity, mostly COPD or diabetes.…”

Section: Discussionmentioning

confidence: 99%

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Chronic Pulmonary Aspergillosis Situation among Post Tuberculosis Patients in Vietnam: An Observational Study

Nguyen

et al. 2021

JoF

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This study provides a brief view of chronic pulmonary aspergillosis (CPA) in the post-tuberculosis treatment community in Vietnam, a high burden tuberculosis (TB) country. In three months in late 2019, 70 post-TB patients managed at Vietnam National Lung Hospital were enrolled. Of these, 38 (54.3%) had CPA. The male/female ratio was 3/1 (28 males and ten females). CPA patients had a mean age of 59 ± 2.3 years (95%CI 54.4–63.6). The mean Body mass index (BMI) was 19.0 ± 0.5 (18.0–20.0) and 16 of 38 (42.1%) patients had concurrent diseases, the most common of which were chronic obstructive pulmonary disease (COPD) and diabetes. Twenty-six patients (68.4%) developed hemoptysis, 21 (55.3%) breathlessness, and weight loss was seen in 30 (78.9%). Anaemia was seen in 15 (39.5%) and 27 of 38 (71.1%) patients had an elevated C-reactive protein (CRP). The most common radiological findings were multiple cavities (52.6%) and pleural thickening (42.7%), followed by aspergilloma (29.0%) and non-specific infiltrates. There were five of 38 patients (13.2%) with a cavity containing a fungal ball on the chest X-ray, but when the high resolution computed tomography (HRCT) was examined, the number of patients with fungal balls rose to 11 (28.9%). Overall, 34 of 38 (89.5%) cases had an elevated Aspergillus IgG with an optical density ≥ 1, and in 2 cases, it was 0.9–1.0 (5%), borderline positive. In nine patients (23.7%) Aspergillus fumigatus was cultured from sputum. CPA is an under-recognised problem in Vietnam and other high burden TB countries, requiring a different diagnostic approach and treatment and careful management. HRCT and Aspergillus IgG serum test are recommended as initial diagnostic tools for CPA diagnosis.

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Section: Discussionmentioning

confidence: 64%

Section: Discussionmentioning

confidence: 99%

Chronic Pulmonary Aspergillosis Situation among Post Tuberculosis Patients in Vietnam: An Observational Study

Nguyen

et al. 2021

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“…Partly using this dataset (end of TB therapy only), and a separate cross-sectional study population (n=71) and both normal and disease controls (n=190), we derived the optimum cut-off for Aspergillus -specific IgG (11.5mg/L) in Indonesia for the Immulite assay [26]. The antibody titres varied substantially between both time points, indicative of a complex interaction between Aspergillus and the immune system during the months of anti-TB therapy.…”

Section: Discussionmentioning

confidence: 99%

“…Blood samples (5-10ml) and sputum (if produced) was collected from patients in the clinic at both time points. Aspergillus-specific IgG level was measured using the Immulite 2000 system (Siemens, Berlin, Germany) according to the manufacturer’s instructions using a cutoff of 11.5 mg/l [26]. Prior to testing, serum was stored in -80°C.…”

Section: Methodsmentioning

confidence: 99%

A prospective longitudinal study of chronic pulmonary aspergillosis in pulmonary tuberculosis in Indonesia (APICAL)

Setianingrum

Rozaliyani

Adawiyah

et al. 2021

Preprint

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Objectives: Chronic pulmonary aspergillosis (CPA) can complicate recovery from pulmonary tuberculosis (TB). CPA may also be misdiagnosed as bacteriologically-negative TB. This study aimed to determine the incidence of CPA in patients treated for TB in Indonesia; a country with a high incidence of TB. Methods: In this prospective, longitudinal cohort study in patients treated for pulmonary TB, clinical, radiological and laboratory findings were analysed. Sputum was collected for fungal culture and TB PCR. Patients were assessed at baseline (0-8 weeks) and at the end (5-6 months) of TB therapy. CPA diagnosis was based on symptoms (>3 months), characteristic radiological features and positive Aspergillus serology, and categorized as proven, probable and possible. Results: Of the 216 patients recruited, 128 (59%) were followed up until end of TB therapy. At baseline, 91 (42%) had microbiological evidence for TB. Aspergillus-specific IgG was positive in 64 (30%) patients and went from negative to positive in 16 (13%) patients during TB therapy. The incidence of proven and probable CPA at baseline was 6% (n=12) and 2% (n=5) and end of TB therapy 8% (n=10) and 5% (n=7), respectively. Six patients (2 with confirmed TB) developed an aspergilloma. Diabetes mellitus was a significant risk factor for CPA (p=0.040). Persistent cough (n=5, 50%; p=0.005) and fatigue (n=6, 60%; p=0.001) were the most common symptoms in CPA. Conclusion: CPA should be considered a relatively frequent differential diagnosis in patients with possible or proven TB in Indonesia. Lack of awareness and limited access to Aspergillus-specific IgG tests and CT imaging are obstacles in establishing a CPA diagnosis.

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“…Persistent and progressive pulmonary symptoms and lung tissue destruction occur in CPA with a high 5-year mortality rate, ranging from 50% to 85% [ 2 , 3 ]. A recent study from Indonesia reported that 13% of patients developed CPA at the end of TB therapy [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Performance of LDBio Aspergillus WB and ICT Antibody Detection in Chronic Pulmonary Aspergillosis

Setianingrum

Azahra

Abdullah

et al. 2021

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The detection of Aspergillus antibody has a key role in the diagnosis of chronic pulmonary aspergillosis. Western blot (WB) and immunochromatography (ICT) lateral flow detection of Aspergillus antibody can be used as confirmatory and screening assays but their comparative performance in TB patients is not known. This study investigated the performance of these assays among 88 post-tuberculosis patients with suspected CPA. Sensitivity, specificity, receiver operating curve (ROC), area under-curve (AUC) and the agreement between two assays were evaluated. Both WB and ICT showed good sensitivity (80% and 85%, respectively) for detection of Aspergillus antibodies. Substantial agreement (0.716) between these assays was also obtained. The highest AUC result (0.804) was achieved with the combination of WB and ICT. The global intensity of WB correlated with the severity of symptoms in CPA group (p = 0.001). The combination of WB and ICT may increase specificity in CPA diagnosis.

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Evaluation and comparison of automated and manual ELISA for diagnosis of chronic pulmonary aspergillosis (CPA) in Indonesia

Cited by 15 publications

References 21 publications

Chronic Pulmonary Aspergillosis Situation among Post Tuberculosis Patients in Vietnam: An Observational Study

Chronic Pulmonary Aspergillosis Situation among Post Tuberculosis Patients in Vietnam: An Observational Study

A prospective longitudinal study of chronic pulmonary aspergillosis in pulmonary tuberculosis in Indonesia (APICAL)

Performance of LDBio Aspergillus WB and ICT Antibody Detection in Chronic Pulmonary Aspergillosis

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