The clinical value of Aspergillus-specific IgG antibody test in the diagnosis of nonneutropenic invasive pulmonary aspergillosis

Yajie Lu; Lulu Liu; Hongxing Li; Bilin Chen; Yu Gu; Li Wang; Chunlai Feng; Cheng Chen; Yanbin Chen; Wenkui Sun; Xuefan Cui; Min Cao; Yujian Tao; Jinjin Zhong; Huanhuan Zhong; Yueyan Ni; Yuchen Cai; Mengyue Song; Xiaoguang Liu; Yi Shi; Xin Su

doi:10.1016/j.cmi.2023.02.002

The clinical value of Aspergillus-specific IgG antibody test in the diagnosis of nonneutropenic invasive pulmonary aspergillosis

Clin Microbiol Infect. 2023 Jun;29(6):797.e1-797.e7. doi: 10.1016/j.cmi.2023.02.002. Epub 2023 Feb 10.

Authors

Yajie Lu¹, Lulu Liu², Hongxing Li³, Bilin Chen², Yu Gu⁴, Li Wang⁵, Chunlai Feng⁶, Cheng Chen⁷, Yanbin Chen⁷, Wenkui Sun⁸, Xuefan Cui⁸, Min Cao⁹, Yujian Tao¹⁰, Jinjin Zhong², Huanhuan Zhong², Yueyan Ni⁴, Yuchen Cai², Mengyue Song⁴, Xiaoguang Liu³, Yi Shi², Xin Su¹¹

Affiliations

¹ Department of Respiratory and Critical Care Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China; Department of Respiratory and Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.
² Department of Respiratory and Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.
³ Department of Respiratory and Critical Care Medicine, Jinling Hospital, Nanjing No.2 Southern Medical University, Guangzhou, China.
⁴ Department of Respiratory and Critical Care Medicine, Jinling Hospital, Nanjing Medical University, Nanjing, China.
⁵ Department of Respiratory and Critical Care Medicine, Nanjing First Hospital, Nanjing, China.
⁶ Department of Respiratory and Critical Care Medicine, Changzhou First People's Hospital, Changzhou, China.
⁷ Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, China.
⁸ Department of Respiratory and Critical Care Medicine, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
⁹ Department of Respiratory and Critical Care Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China.
¹⁰ Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Yangzhou University, Yangzhou, China.
¹¹ Department of Respiratory and Critical Care Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China; Department of Respiratory and Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China; Department of Respiratory and Critical Care Medicine, Jinling Hospital, Nanjing No.2 Southern Medical University, Guangzhou, China; Department of Respiratory and Critical Care Medicine, Jinling Hospital, Nanjing Medical University, Nanjing, China. Electronic address: suxinjs@163.com.

PMID: 36773771
DOI: 10.1016/j.cmi.2023.02.002

Abstract

Objectives: Aspergillus-specific IgG antibody (Asp IgG) has been successfully applied in the diagnosis of chronic pulmonary aspergillosis. We explored its value in nonneutropenic invasive pulmonary aspergillosis (IPA) by a multicenter, prospective, and controlled study.

Methods: We enrolled 372 clinically suspected nonneutropenic patients with IPA from February 2015 to August 2022. After excluding 4 cases with Aspergillus colonization, the remaining 368 cases were finally confirmed as patients with IPA (n = 99), or non-IPA patients (n = 269) consisting of community-acquired pneumonia (n = 206), tuberculosis (n = 22), nontuberculous mycobacteria (n = 5), lung abscess (n = 6), or noninfectious diseases (n = 30). Asp IgG in plasma samples was tested by enzyme-linked immunosorbent assay.

Results: At cut-off value of ≥80 AU/mL, Asp IgG had much higher sensitivity (59.6% vs. 19.2%, p < 0.0001), but lower specificity (77.0% vs. 96.3%, p < 0.0001) than serum galactomannan (GM) (cut-off value of ≥1.0), and similar sensitivity (59.6% vs. 55.6%, p = 0.611) but lower specificity (77.0% vs. 91.2%, p = 0.001) than bronchoalveolar lavage fluid (BALF) GM (cut-off value of ≥1.0), respectively. Combination diagnosis of either positive for Asp IgG or BALF GM had higher sensitivity (81.0% vs. 55.6%, p = 0.002), but lower specificity (75.2% vs. 91.2%, p = 0.001) than BALF GM alone. The receiver operating characteristic curve showed that Asp IgG had an optimal diagnostic value when the cut-off value was 56.6 AU/ml, and the sensitivity and specificity were 77.8% and 63.9%, respectively.

Discussions: The diagnostic value of Asp IgG for IPA is superior to serum GM, and a little inferior to BALF GM in nonneutropenic patients with IPA. Considering the convenience of taking blood samples, it is a good screening and diagnostic method for nonneutropenic patients with IPA, especially for those who cannot bear invasive procedures.

Keywords: Aspergillus-specific IgG antibody; Diagnosis; Invasive pulmonary aspergillosis; Nonneutropenic patients; Plasma.

Publication types

Multicenter Study

MeSH terms

Antibodies, Fungal
Aspergillus
Bronchoalveolar Lavage Fluid / microbiology
Humans
Immunoglobulin G
Invasive Pulmonary Aspergillosis* / diagnosis
Mannans
Prospective Studies
Pulmonary Aspergillosis*
Sensitivity and Specificity

Substances

Immunoglobulin G
Antibodies, Fungal
Mannans