Influence of mould-active antifungal treatment on the performance of the Aspergillus-specific bronchoalveolar lavage fluid lateral-flow device test

Eigl, Susanne; Prattes, Juergen; Reinwald, Mark; Thornton, Christopher R.; Reischies, Frederike; Spieß, Birgit; Neumeister, Peter; Zollner‐Schwetz, Ines; Raggam, Reinhard B.; Flick, Holger; Buchheidt, Dieter; Krause, Robert; Hoenigl, Martin

doi:10.1016/j.ijantimicag.2015.05.017

Cited by 78 publications

(78 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Early and reliable diagnosis and rapid initiation of appropriate antifungal therapy has been shown to improve survival significantly [6, 7]. Culture-based approaches are important for detection of fungal species and resistance testing; however, they are limited by low sensitivities—in particular during early phases of infection—and long turnaround time [8•]. Significant advances to the field were brought by the introduction of non-cultural diagnostic tests for IA in blood and bronchoalveolar lavage fluid (BALF), including galactomannan antigen (GM) testing [9•, 10 –13], PCR [14••, 15, 16••, 17], and beta- d -glucan (BDG) testing [18–24] in patients at risk [25•, 26, 27, 28•, 29].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Lateral Flow Assays for the Diagnosis of Invasive Aspergillosis: Current Status

Heldt

Hoenigl

2017

Curr Fungal Infect Rep

Self Cite

View full text Add to dashboard Cite

Purpose of ReviewDiagnosis during early stages of invasive aspergillosis (IA) and targeted antifungal treatment has the potential to improve survival significantly. Despite advances in the diagnostic arsenal, invasive mold infections remain difficult to diagnose—especially at early stages before typical radiological signs develop. Varying availability and time-to-results are important limitations of current approved biomarkers and molecular assays for diagnosis of IA. Here, we will give an update on the Aspergillus-specific lateral-flow device (LFD) test. We further review promising findings on feasibility of point-of-care (POC) detection of urinary excreted fungal galactomannan-like antigens.Recent FindingsPOC LFD assays for detection of Aspergillus antigens are currently in development. The Aspergillus-specific LFD test, which is based on the JF5 antibody (Ab), detects an extracellular glycoprotein antigen secreted during active growth of Aspergillus spp. The test has shown promising results in various studies. In addition, a monoclonal Ab476-based LFD for POC detection of urinary excreted fungal galactomannan-like antigens has been developed but needs further validation.SummaryImportant advances have been made in the development of LFD assays for IA. Most promising is the Aspergillus-specific LFD test; commercial availability is still pending, however. The search for reliable POC tests for other molds, including mucorales, continues.

show abstract

Section: Introductionmentioning

confidence: 99%

“… PPV positive predictive value, NPV negative predictive value a Data derived from published studies [8•, 16••, 28•, 32, 33, 39–47, 48••]: b Overall summarizes unique samples and is lower than the sum of subgroup samples, as some samples were classified into more than one subgroup…”

Section: Introductionmentioning

confidence: 99%

Lateral Flow Assays for the Diagnosis of Invasive Aspergillosis: Current Status

Heldt

Hoenigl

2017

Curr Fungal Infect Rep

Self Cite

View full text Add to dashboard Cite

show abstract

“…In patients with IA GM is measurable in peripheral blood (serum and plasma), bronchoalveolar lavage fluid (BALF), urine, cerebral spinal fluid, or pleural fluid. [10][11][12][13][14] The test, however, has important limitations. As false positive results may occur, factors such as co-medication, underlying diseases, host factors, diagnostic imaging, clinical signs, and former medication of the patient must be taken into account for the correct interpretation of GM levels.…”

Section: Introductionmentioning

confidence: 99%

Galactomannan testing andAspergillusPCR in same-day bronchoalveolar lavage and blood samples for diagnosis of invasive aspergillosis

et al. 2016

Self Cite

View full text Add to dashboard Cite

In recent years galactomannan antigen testing (GM) and also Aspergillus PCR have become increasingly important for diagnosis of invasive aspergillosis (IA). Whether or not these tests need to be performed with bronchoalveolar lavage fluid (BALF; i.e., primary site of infection), or testing of blood samples is sufficient, remains, however, a matter of debate. We evaluated the diagnostic performance of GM ELISA, and Aspergillus PCR by using BALF samples and blood samples obtained at the same day from a total of 53 immunocompromised patients (16 with probable/proven IA and 37 with no evidence of IA according to the revised EORTC/MSG criteria; 38 patients with hematological malignancies were prospectively enrolled at the Medical University of Graz, Austria, 15 patients with mixed underlying diseases at the Mannheim University Hospital). Patients with possible IA were excluded from this analysis. A total of 34/53 (64%) of all patients and 12/16 (75%) of patients with probable/proven IA received mold-active antifungal prophylaxis/therapy at the time of the BALF procedure. Sensitivities of GM and Aspergillus PCR were 38% and 44% in BALF, and 31% and 0% in blood, respectively. Best sensitivity (75%) for detecting proven/probable IA was achieved when BALF Aspergillus PCR, BALF Eigl et al. 529GM (>1.0 ODI), BALF-culture and serum-GM (>0.5 ODI) were combined (specificity 95%).In conclusion, sensitivities of the evaluated diagnostic tests-when interpreted on their own-were low in BALF and even lower in blood, sensitivities increased markedly when diagnostic tests were combined.

show abstract

“…Recent data, however, indicate that, in the presence of mold-active antifungal prophylaxis or treatment, sensitivity of this method drops to 52%, thereby compromising its utility in this scenario [21]. …”

Section: Casementioning

confidence: 99%

A Review of Diagnostic Methods for Invasive Fungal Diseases: Challenges and Perspectives

2017

View full text Add to dashboard Cite

Invasive fungal diseases are associated with a high morbidity and mortality, particularly in the context of immunosuppression. Diagnosis of invasive fungal diseases is usually complicated by factors such as poor clinical suspicion and unspecific clinical findings. Access to modern diagnostic tools is frequently limited in developing countries. Here, we describe five real-life clinical cases from a Brazilian tertiary hospital, in order to illustrate how to best select diagnostic tests in patients with different fungal infections.

show abstract

Influence of mould-active antifungal treatment on the performance of the Aspergillus-specific bronchoalveolar lavage fluid lateral-flow device test

Cited by 78 publications

References 28 publications

Lateral Flow Assays for the Diagnosis of Invasive Aspergillosis: Current Status

Lateral Flow Assays for the Diagnosis of Invasive Aspergillosis: Current Status

Galactomannan testing andAspergillusPCR in same-day bronchoalveolar lavage and blood samples for diagnosis of invasive aspergillosis

A Review of Diagnostic Methods for Invasive Fungal Diseases: Challenges and Perspectives

Contact Info

Product

Resources

About