Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran.
Department of Medical Mycology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
Mycoses. 2022 Oct;65(10):960-968. doi: 10.1111/myc.13518. Epub 2022 Aug 25.
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 with GM-EIA. Herein we compared the diagnostic features of GM-LFA, GM-EIA and bronchoalveolar lavage (BAL) culture for CAPA diagnosis in Iran, a developing country.
MATERIALS/METHODS: Diagnostic performances 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.
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 with 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.
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.
半乳甘露聚糖酶免疫分析（GM-EIA）已被证实是诊断 COVID-19 相关肺曲霉病（CAPA）的基石，但其在中低收入国家的应用受到限制，在这些国家，人们高度赞赏应用简单、快速的检测方法，包括半乳甘露聚糖侧向流动检测（GM-LFA）。尽管具有这些优点，但直接比较 GM-LFA 与 GM-EIA 的研究有限。本文比较了 GM-LFA、GM-EIA 和支气管肺泡灌洗（BAL）培养在伊朗（一个发展中国家）用于 CAPA 诊断的诊断特征。
材料/方法：使用 GM-LFA 和 GM-EIA 检测 BAL（GM 指数≥1）和血清（GM 指数>0.5）中的诊断性能，即敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）和曲线下面积（AUC），评估了来自重症监护病房机械通气的 COVID-19 患者的 BAL（n=105）和血清（n=101）样本。根据宿主因素、影像学表现和 2020 年 ECMM/ISHAM CAPA 诊断共识标准的真菌学证据，对患者进行分类。
曲霉 GM-LFA 检测血清和 BAL 样本的敏感性分别为 56.3%和 60.6%，特异性分别为 94.2%和 88.9%，PPV 分别为 81.8%和 71.4%，NPV 分别为 82.3%和 83.1%，与 BAL 培养相比。GM-EIA 检测血清和 BAL 样本的敏感性分别为 46.9%和 54.5%，特异性分别为 100%和 91.7%，PPV 分别为 100%和 75%，NPV 分别为 80.2%和 81.5%。
本研究发现 GM-LFA 是一种可靠的简单、快速的诊断工具，可以避免培养和 GM-EIA 的缺点，并在及时启动抗真菌治疗方面发挥关键作用。
