Role of <i>Aspergillus fumigatus</i>‐specific IgG in diagnosis and monitoring treatment response in allergic bronchopulmonary aspergillosis

Agarwal, Ritesh; Dua, Devika; Choudhary, Hansraj; Aggarwal, Ashutosh N.; Sehgal, Inderpaul Singh; Dhooria, Sahajal; Garg, Mandeep; Behera, Digambar; Chakrabarti, Arunaloke

doi:10.1111/myc.12541

Cited by 67 publications

(85 citation statements)

References 43 publications

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“…In the current study, A fumigatus ‐specific IgG had a moderate sensitivity but excellent specificity for diagnosing SA. Although the cut‐off value is similar to that used in other forms of chronic aspergillosis (CCPA and ABPA), the lower sensitivity is possibly due to the saprophytic nature of the infection …”

Section: Discussionmentioning

confidence: 99%

Efficiency of A fumigatus‐specific IgG and galactomannan testing in the diagnosis of simple aspergilloma

Sehgal

Dhooria

Choudhary

et al. 2019

Mycoses

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Summary Background An early diagnosis of chronic pulmonary aspergillosis (CPA) at the stage of simple aspergilloma (SA) remains a challenge in low‐ and middle‐income countries, where imaging may not be routinely available.ObjectiveWe investigate the role of Aspergillus fumigatus‐specific IgG in serum, and galactomannan (GM) in bronchoalveolar lavage fluid (BALF) and serum for the diagnosis of SA.MethodsWe included 46 consecutive treatment‐naïve subjects with SA. The 81 controls were subjects of treated pulmonary tuberculosis with residual radiological abnormality and minimal symptoms; and subjects with pulmonary disorders other than CPA who underwent bronchoscopy. The diagnosis of SA was based on consistent clinical features along with radiological manifestations (cavity with fungal ball).ResultsUsing receiver operating characteristic (ROC) curve analysis, the best cut‐off value for A fumigatus‐specific IgG was 27.3 mgA/L (AUROC, 0.839; sensitivity, 63.5%; specificity, 98.3%). The best cut‐off value for serum and BALF‐GM was 0.7 (AUROC, 0.636; sensitivity, 32%; specificity, 96.2%) and 2.5 (AUROC, 0.833; sensitivity, 63.7%; specificity, 97.1%), respectively. A combination of A fumigatus‐specific IgG (>27 mgA/L) or serum GM (≥0.7) or BALF‐GM (≥2.5) had a sensitivity and specificity of 82.6% and 96%, respectively.ConclusionsA combination of serological tests has the best sensitivity in diagnosing SA. More studies are needed to confirm our findings.

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Section: Discussionmentioning

confidence: 99%

Efficiency of A fumigatus‐specific IgG and galactomannan testing in the diagnosis of simple aspergilloma

Sehgal

Dhooria

Choudhary

et al. 2019

Mycoses

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“…They are well suited for longitudinal follow‐up . We and others are currently analyzing the association of enhanced IgG detection and quantitation results with clinical Aspergillus disease presentations . Indeed, the comparative assessment of quantitative IgE, IgG, and presence or absence of A. fumigatus is still to do in patients with CF, despite early studies showing clinically significant interplay of these features in CF patients with or without ABPA and recent work uncovering a similar interplay in common airborne allergies of large cohorts …”

Section: Why Should Immunological Criteria For Abpa Diagnosis Be Updamentioning

confidence: 99%

“…A first step toward an integrated IgE and IgG workup might be the use of a single method for head‐to‐head comparison. This is feasible with current routine autoanalyzers, with very good quantitative performances including interlaboratory comparison …”

Section: Component‐resolved Diagnostics: Molecular Aspects Of the Hummentioning

confidence: 99%

Aspergillus fumigatus in cystic fibrosis: An update on immune interactions and molecular diagnostics in allergic bronchopulmonary aspergillosis

Carsin

Romain

Ranque

et al. 2017

Allergy

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A wide spectrum of pathological conditions may result from the interaction of Aspergillus fumigatus and the immune system of its human host. Allergic bronchopulmonary aspergillosis is one of the most severe A. fumigatus-related diseases due to possible evolution toward pleuropulmonary fibrosis and respiratory failure. Allergic bronchopulmonary aspergillosis occurs almost exclusively in cystic fibrosis or asth- | ASPERGILLUS FUMIGATUS AND ITS INTERACTION WITH THE HUMAN HOSTThe Aspergillus genus comprises 339 species of filamentous fungi ubiquitous all over the world in human environment, for example, air, soil, cereals, fruit, plants, wet and decomposing organic matter.Airborne Aspergillus spp spores are present indoors and outdoors, with an estimated 10-1000 spores inhaled daily by each human. 4,5 A growing number of Aspergillus species are recognized as pathogenic for animals and humans; yet A. fumigatus (Figure 1) The pathophysiological continuum of A. fumigatus-host interaction is mirrored by laboratory and clinical frames of "asymptomatic"colonization, "benign" IgE sensitization to A. fumigatus, through A. fumigatus-induced cough and asthma, to aspergilloma and invasive aspergilloses. However, the first two stages lack consensus definitions. The growth of A. fumigatus in the airways, also termed "car- irreversible, calls for updating the immunological criteria have been accumulating since the turn of the century. 47,52,60 These calls are supported by novel tools with enhanced performance.We will describe hereafter the issues associated with the current ABPA immunological diagnostic criteria including total serum IgE,A. fumigatus-specific IgE, and A. fumigatus-specific IgG and precipitins against A. fumigatus.

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“…The modest results (sensitivity 50.0% and specificity 88.9% for SI CD203c, at a cut‐off of 1.2) suggests a limited utility of this investigation in differentiating ABPA from ASA and UA. In comparison, A fumigatus ‐specific IgE and IgG had a sensitivity of 100% and 88% and specificity of 69%‐78% and 100%, at a cut‐off of 0.35 kUA/L and 27 mgA/L, respectively 33,34 . Moreover, it should be borne in mind that only a few immunology laboratories have the equipment and expertise to perform flow cytometry.…”

Section: Discussionmentioning

confidence: 99%

The utility of the basophil activation test in differentiating asthmatic subjects with and without allergic bronchopulmonary aspergillosis

Prasad

Muthu

Sehgal

et al. 2020

Mycoses

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Summary Background Asthma with Aspergillus sensitisation (ASA) and allergic bronchopulmonary aspergillosis (ABPA) are distinct clinical conditions, with different management strategies. Objective To determine the utility of the basophil activation test (BAT) in differentiating between asthmatic subjects with and without ABPA. Methods We performed the BAT using flow cytometry for the basophil activation markers CD63, CD193, and CD203c in consecutive subjects with unsensitised asthma (UA), ASA and ABPA. The BAT was performed unstimulated (baseline) and after stimulation with peanut and Aspergillus fumigatus antigens. Stimulation indices (SI) for CD63, CD193 and CD203c were compared between the study groups. Results We enrolled 82 (UA [n = 25], ASA [n = 25], ABPA [n = 32]) subjects. Only those subjects without peanut sensitisation on serological testing were included in further analyses (n = 50). The receiver operating characteristic analysis of SI for CD63, CD193 and CD203c for the diagnosis of ABPA vs other asthmatics (UA and ASA) showed an area under the curve of 0.577, 0.317 and 0.625, respectively. The SI CD203c at a cut‐off of 1.2 (sensitivity 50.0%, specificity 88.9%) and the SI CD63 at a cut‐off of 1.3 (sensitivity 42.9%, specificity 91.7%) also had limited utility for the diagnosis of ABPA. Conclusion The BAT cannot be used as a diagnostic test in distinguishing ABPA complicating asthma from ASA and UA.

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Role of Aspergillus fumigatus‐specific IgG in diagnosis and monitoring treatment response in allergic bronchopulmonary aspergillosis

Cited by 67 publications

References 43 publications

Efficiency of A fumigatus‐specific IgG and galactomannan testing in the diagnosis of simple aspergilloma

Efficiency of A fumigatus‐specific IgG and galactomannan testing in the diagnosis of simple aspergilloma

Aspergillus fumigatus in cystic fibrosis: An update on immune interactions and molecular diagnostics in allergic bronchopulmonary aspergillosis

The utility of the basophil activation test in differentiating asthmatic subjects with and without allergic bronchopulmonary aspergillosis

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