Salehi Mohammadreza, Salmanton-García Jon, Abdollahi Alireza, Albaji Maryam, Davoudi-Monfared Effat, Siami Zeinab, Mohammadi Saeed, Khodavaisy Sadegh, Nazemi Pershang
Research Center for Antibiotic Stewardship & Antimicrobial Resistance, Department of Infectious Diseases, Imam Khomeini Hospital Complex, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
University of Cologne, Faculty of Medicine, and University Hospital Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany.
Iran J Pathol. 2025 Spring;20(2):142-151. doi: 10.30699/ijp.2025.2044324.3369. Epub 2025 Mar 10.
COVID-19-associated pulmonary aspergillosis (CAPA) is a complication of COVID-19. Galactomannan (GM) is a non-invasive test used to diagnose invasive aspergillosis. We collected the existing studies on the diagnostic value of GM to determine a GM level for predicting CAPA. All articles on the value of GM in CAPA diagnosis published until November 2023 were reviewed. The main databases were searched using the following keywords: "aspergillus", "aspergillosis", "SARS-CoV-2", "COVID", "2019 ncovnCOV", "novel coronavirus", "COVID-19", "galactomannan", and "CAPA". Studies with reported levels of serum or BAL GM were included. Patients were classified into two groups: non-confirmed and proven aspergillosis. Finally, the receiver operating characteristic (ROC) curve analysis was used to determine a GM level to predict the likelihood of CAPA. A total of 26 articles were selected, of which 239 patients were included. A count of 123 patients (50%) were in the non-confirmed group and 124 (50%) patients were proven. The median serum GM was 0.51 in the non-confirmed group and 0.47 in the proven group (p= 0.73). The level of GM in BAL fluid was 0.10 in the non-confirmed and 2.80 in the proven group, which was statistically different (p<0.001). With 81.3 % sensitivity and 79.5% specificity, the BAL GM cut-off was 1.01 ODI. The results showed that BAL GM ≥1.01 can be used to predict CAPA. Serum GM did not show any predictive value in diagnosing CAPA. However, BAL GM level can be a reliable diagnostic test in patients with CAPA.
新型冠状病毒肺炎相关肺曲霉病（CAPA）是新型冠状病毒肺炎的一种并发症。半乳甘露聚糖（GM）是一种用于诊断侵袭性曲霉病的非侵入性检测方法。我们收集了关于GM诊断价值的现有研究，以确定预测CAPA的GM水平。对截至2023年11月发表的所有关于GM在CAPA诊断中价值的文章进行了综述。使用以下关键词搜索主要数据库：“曲霉属”、“曲霉病”、“严重急性呼吸综合征冠状病毒2”、“新型冠状病毒肺炎”、“2019新型冠状病毒”、“新型冠状病毒”、“新型冠状病毒肺炎”、“半乳甘露聚糖”和“CAPA”。纳入报告了血清或支气管肺泡灌洗（BAL）GM水平的研究。患者分为两组：未确诊和确诊曲霉病。最后，采用受试者操作特征（ROC）曲线分析来确定预测CAPA可能性的GM水平。共选择了26篇文章，其中纳入了239例患者。123例患者（50%）属于未确诊组，124例患者（50%）确诊。未确诊组血清GM中位数为0.51，确诊组为0.47（p = 0.73）。BAL液中GM水平在未确诊组为0.10，确诊组为2.80，差异有统计学意义（p<0.001）。BAL GM临界值为1.01光学密度指数（ODI），敏感性为81.3%，特异性为79.5%。结果表明，BAL GM≥1.01可用于预测CAPA。血清GM在诊断CAPA中未显示出任何预测价值。然而，BAL GM水平可作为CAPA患者可靠的诊断检测方法。
