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Semin Respir Crit Care Med 2024; 45(01): 021-031
DOI: 10.1055/s-0043-1776777
Review Article

Microbiological Diagnosis of Pulmonary Aspergillus Infections

Robina Aerts
1   Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
2   Department of Internal Medicine, University Hospitals Leuven, Leuven, Belgium
,
Simon Feys
1   Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
3   Medical Intensive Care Unit, University Hospitals Leuven, Leuven, Belgium
,
Toine Mercier
1   Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
4   Department of Oncology-Hematology, AZ Sint-Maarten, Mechelen, Belgium
,
Katrien Lagrou
1   Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
5   Department of Laboratory Medicine and National Reference Center for Mycosis, University Hospitals Leuven, Leuven, Belgium
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Abstract

As microbiological tests play an important role in our diagnostic algorithms and clinical approach towards patients at-risk for pulmonary aspergillosis, a good knowledge of the diagnostic possibilities and especially their limitations is extremely important. In this review, we aim to reflect critically on the available microbiological diagnostic modalities for diagnosis of pulmonary aspergillosis and formulate some future prospects. Timely start of adequate antifungal treatment leads to a better patient outcome, but overuse of antifungals should be avoided. Current diagnostic possibilities are expanding, and are mainly driven by enzyme immunoassays and lateral flow device tests for the detection of Aspergillus antigens. Most of these tests are directed towards similar antigens, but new antibodies towards different targets are under development. For chronic forms of pulmonary aspergillosis, anti-Aspergillus IgG antibodies and precipitins remain the cornerstone. More studies on the possibilities and limitations of molecular testing including targeting resistance markers are ongoing. Also, metagenomic next-generation sequencing is expanding our future possibilities. It remains important to combine different test results and interpret them in the appropriate clinical context to improve performance. Test performances may differ according to the patient population and test results may be influenced by timing, the tested matrix, and prophylactic and empiric antifungal therapy. Despite the increasing armamentarium, a simple blood or urine test for the diagnosis of aspergillosis in all patient populations at-risk is still lacking. Research on diagnostic tools is broadening from a pathogen focus on biomarkers related to the patient and its immune system.

Keywords

invasive aspergillosis - microbiological diagnosis - galactomannan - Aspergillus antigen - Aspergillus PCR - lateral flow assay


Publication History

Article published online:
16 January 2024

© 2024. Thieme. All rights reserved.

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  • References

  • 1 Donnelly JP, Chen SC, Kauffman CA. et al. Revision and update of the consensus definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium. Clin Infect Dis 2020; 71 (06) 1367-1376
    CrossrefPubMedSearch in Google Scholar
  • 2 Denning DW, Cadranel J, Beigelman-Aubry C. et al; European Society for Clinical Microbiology and Infectious Diseases and European Respiratory Society. Chronic pulmonary aspergillosis: rationale and clinical guidelines for diagnosis and management. Eur Respir J 2016; 47 (01) 45-68
    CrossrefPubMedSearch in Google Scholar
  • 3 Winters B, Custer J, Galvagno Jr SM. et al. Diagnostic errors in the intensive care unit: a systematic review of autopsy studies. BMJ Qual Saf 2012; 21 (11) 894-902
    CrossrefPubMedSearch in Google Scholar
  • 4 Tejerina EE, Abril E, Padilla R. et al. Invasive aspergillosis in critically ill patients: an autopsy study. Mycoses 2019; 62 (08) 673-679
    CrossrefPubMedSearch in Google Scholar
  • 5 Danion F, Rouzaud C, Duréault A. et al. Why are so many cases of invasive aspergillosis missed?. Med Mycol 2019; 57 (Suppl. 02) S94-S103
    CrossrefPubMedSearch in Google Scholar
  • 6 Vanderbeke L, Jacobs C, Feys S. et al. A pathology-based case series of Influenza- and COVID-19-associated pulmonary aspergillosis: the proof is in the tissue. Am J Respir Crit Care Med 2023; 208 (03) 301-311
    CrossrefPubMedSearch in Google Scholar
  • 7 Guegan H, Iriart X, Bougnoux M-E, Berry A, Robert-Gangneux F, Gangneux J-P. Evaluation of MucorGenius® mucorales PCR assay for the diagnosis of pulmonary mucormycosis. J Infect 2020; 81 (02) 311-317
    CrossrefPubMedSearch in Google Scholar
  • 8 Millon L, Caillot D, Berceanu A. et al. Evaluation of serum Mucorales polymerase chain reaction (PCR) for the diagnosis of mucormycoses: The MODIMUCOR Prospective Trial. Clin Infect Dis 2022; 75 (05) 777-785
    CrossrefPubMedSearch in Google Scholar
  • 9 Aerts R, Bevers S, Beuselinck K, Schauwvlieghe A, Lagrou K, Maertens J. Blood Mucorales PCR to track down Aspergillus and Mucorales co-infections in at-risk hematology patients: a case-control study. Front Cell Infect Microbiol 2022; 12: 1080921
    CrossrefPubMedSearch in Google Scholar
  • 10 Kradin RL, Mark EJ. The pathology of pulmonary disorders due to Aspergillus spp. Arch Pathol Lab Med 2008; 132 (04) 606-614
    CrossrefPubMedSearch in Google Scholar
  • 11 Roden AC, Schuetz AN. Histopathology of fungal diseases of the lung. Semin Diagn Pathol 2017; 34 (06) 530-549
    CrossrefPubMedSearch in Google Scholar
  • 12 Girmenia C, Nucci M, Martino P. Clinical significance of Aspergillus fungaemia in patients with haematological malignancies and invasive aspergillosis. Br J Haematol 2001; 114 (01) 93-98
    CrossrefPubMedSearch in Google Scholar
  • 13 Lamoth F, Cruciani M, Mengoli C. et al; Third European Conference on Infections in Leukemia (ECIL-3). β-Glucan antigenemia assay for the diagnosis of invasive fungal infections in patients with hematological malignancies: a systematic review and meta-analysis of cohort studies from the Third European Conference on Infections in Leukemia (ECIL-3). Clin Infect Dis 2012; 54 (05) 633-643
    CrossrefPubMedSearch in Google Scholar
  • 14 Mercier T, Guldentops E, Patteet S, Beuselinck K, Lagrou K, Maertens J. Beta-d-glucan for diagnosing Pneumocystis pneumonia: a direct comparison between the Wako β-Glucan Assay and the Fungitell Assay. J Clin Microbiol 2019; 57 (06) e00322-19 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6535610/
    CrossrefPubMedSearch in Google Scholar
  • 15 Hachem RY, Kontoyiannis DP, Chemaly RF, Jiang Y, Reitzel R, Raad I. Utility of galactomannan enzyme immunoassay and (1,3) beta-D-glucan in diagnosis of invasive fungal infections: low sensitivity for Aspergillus fumigatus infection in hematologic malignancy patients. J Clin Microbiol 2009; 47 (01) 129-133
    CrossrefPubMedSearch in Google Scholar
  • 16 Sulahian A, Porcher R, Bergeron A. et al. Use and limits of (1-3)-β-d-glucan assay (Fungitell), compared to galactomannan determination (Platelia Aspergillus), for diagnosis of invasive aspergillosis. J Clin Microbiol 2014; 52 (07) 2328-2333
    CrossrefPubMedSearch in Google Scholar
  • 17 Lehrnbecher T, Robinson PD, Fisher BT. et al. Galactomannan, β-D-glucan, and polymerase chain reaction-based assays for the diagnosis of invasive fungal disease in pediatric cancer and hematopoietic stem cell transplantation: a systematic review and meta-analysis. Clin Infect Dis 2016; 63 (10) 1340-1348
    CrossrefPubMedSearch in Google Scholar
  • 18 White SK, Walker BS, Hanson KE, Schmidt RL. Diagnostic accuracy of β-d-Glucan (Fungitell) testing among patients with hematologic malignancies or solid organ tumors: a systematic review and meta-analysis. Am J Clin Pathol 2019; 151 (03) 275-285
    CrossrefPubMedSearch in Google Scholar
  • 19 Mercier T, Castagnola E, Marr KA, Wheat LJ, Verweij PE, Maertens JA. Defining galactomannan positivity in the Updated EORTC/MSGERC Consensus Definitions of Invasive Fungal Diseases. Clin Infect Dis 2021; 72 (Suppl. 02) S89-S94
    CrossrefPubMedSearch in Google Scholar
  • 20 Salmanton-García J, Hoenigl M, Gangneux J-P. et al. The current state of laboratory mycology and access to antifungal treatment in Europe: a European Confederation of Medical Mycology survey. Lancet Microbe 2023; 4 (01) e47-e56
    CrossrefPubMedSearch in Google Scholar
  • 21 Leeflang MM, Debets-Ossenkopp YJ, Wang J. et al. Galactomannan detection for invasive aspergillosis in immunocompromised patients. Cochrane Database Syst Rev 2015; 2015 (12) CD007394 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6483812/
    PubMedSearch in Google Scholar
  • 22 Pfeiffer CD, Fine JP, Safdar N. Diagnosis of invasive aspergillosis using a galactomannan assay: a meta-analysis. Clin Infect Dis 2006; 42 (10) 1417-1427
    CrossrefPubMedSearch in Google Scholar
  • 23 Arvanitis M, Anagnostou T, Mylonakis E. Galactomannan and polymerase chain reaction-based screening for invasive aspergillosis among high-risk hematology patients: a diagnostic meta-analysis. Clin Infect Dis 2015; 61 (08) 1263-1272
    CrossrefPubMedSearch in Google Scholar
  • 24 Zou M, Tang L, Zhao S. et al. Systematic review and meta-analysis of detecting galactomannan in bronchoalveolar lavage fluid for diagnosing invasive aspergillosis. PLoS ONE 2012; 7 (08) e43347
    CrossrefPubMedSearch in Google Scholar
  • 25 Guo Y-L, Chen Y-Q, Wang K, Qin S-M, Wu C, Kong J-L. Accuracy of BAL galactomannan in diagnosing invasive aspergillosis: a bivariate metaanalysis and systematic review. Chest 2010; 138 (04) 817-824
    CrossrefPubMedSearch in Google Scholar
  • 26 Heng SC, Morrissey O, Chen SC-A. et al. Utility of bronchoalveolar lavage fluid galactomannan alone or in combination with PCR for the diagnosis of invasive aspergillosis in adult hematology patients: a systematic review and meta-analysis. Crit Rev Microbiol 2015; 41 (01) 124-134
    CrossrefPubMedSearch in Google Scholar
  • 27 White PL, Jones T, Whittle K, Watkins J, Barnes RA. Comparison of galactomannan enzyme immunoassay performance levels when testing serum and plasma samples. Clin Vaccine Immunol 2013; 20 (04) 636-638
    CrossrefPubMedSearch in Google Scholar
  • 28 EBMT. EBMT Handbook. Available from: https://www.ebmt.org/education/ebmt-handbook . Accessed August 8, 2023
    PubMed
  • 29 Vergidis P, Razonable RR, Wheat LJ. et al. Reduction in false-positive Aspergillus serum galactomannan enzyme immunoassay results associated with use of piperacillin-tazobactam in the United States. J Clin Microbiol 2014; 52 (06) 2199-2201
    CrossrefPubMedSearch in Google Scholar
  • 30 Spriet I, Lagrou K, Maertens J, Willems L, Wilmer A, Wauters J. Plasmalyte: no longer a culprit in causing false-positive galactomannan test results. J Clin Microbiol 2016; 54 (03) 795-797
    CrossrefPubMedSearch in Google Scholar
  • 31 Duarte RF, Sánchez-Ortega I, Cuesta I. et al. Serum galactomannan-based early detection of invasive aspergillosis in hematology patients receiving effective antimold prophylaxis. Clin Infect Dis 2014; 59 (12) 1696-1702
    CrossrefPubMedSearch in Google Scholar
  • 32 Aerts R, Cuypers L, Mercier T, Maertens J, Lagrou K. Implementation of lateral flow assays for the diagnosis of invasive aspergillosis in European Hospitals: a survey from Belgium and a literature review of test performances in different patient populations. Mycopathologia 2023; 188 (05) 655-665
    CrossrefPubMedSearch in Google Scholar
  • 33 Mercier T, Verweij P, Lehrnbecher T. et al. Update on fungal diagnostics ECIL-9. Paper presented at: 9th European Conference on Infections in Leukaemia Resources. September 15-17, 2022 . Available from: https://ecil-leukaemia.com/en/resources/resources-ecil . Accessed July 14, 2023
    PubMedSearch in Google Scholar
  • 34 Buil JB, Huygens S, Dunbar A. et al. Retrospective multicenter evaluation of the VirClia galactomannan antigen assay for the diagnosis of pulmonary aspergillosis with bronchoalveolar lavage fluid samples from patients with hematological disease. J Clin Microbiol 2023; 61 (05) e0004423
    CrossrefPubMedSearch in Google Scholar
  • 35 Troncoso C R, Sepúlveda F C, Sepúlveda P E, Guzmán U C, Morales G M, Tapia P C. [Evaluation of the Aspergillus Galactomannan ag VircliaR Monotest test as an alternative to Platelia™ Aspergillus EIA kit]. Rev Chilena Infectol 2022; 39 (03) 248-253
    CrossrefPubMedSearch in Google Scholar
  • 36 Calero AL, Alonso R, Gadea I. et al. Comparison of the performance of two galactomannan detection tests: Platelia Aspergillus Ag and Aspergillus Galactomannan Ag Virclia Monotest. Microbiol Spectr 2022; 10 (02) e0262621
    CrossrefPubMedSearch in Google Scholar
  • 37 Dufresne SF, Datta K, Li X. et al. Detection of urinary excreted fungal galactomannan-like antigens for diagnosis of invasive aspergillosis. PLoS ONE 2012; 7 (08) e42736
    CrossrefPubMedSearch in Google Scholar
  • 38 Marr KA, Datta K, Mehta S. et al. Urine antigen detection as an aid to diagnose invasive aspergillosis. Clin Infect Dis 2018; 67 (11) 1705-1711
    PubMedSearch in Google Scholar
  • 39 Cornely OA, Gow N, Hoenigl M, Warris A. 10th Trends in Medical Mycology Held on 8 to 11 October 2021, Aberdeen, Scotland, Organized by the European Confederation of Medical Mycology (ECMM). J Fungi (Basel) 2021; 7 (11) 916
    CrossrefPubMedSearch in Google Scholar
  • 40 Marr KA. ECCMID 2023 - Development and performance of MycoMEIA - Aspergillus: a new urine diagnostic for aspergillosis. April 15-18, 2023 . Available from: https://online.eccmid.org/ http://online.eccmid.org/container-detail.php?id=5061
    PubMedSearch in Google Scholar
  • 41 White PL, Bretagne S, Klingspor L. et al; European Aspergillus PCR Initiative. Aspergillus PCR: one step closer to standardization. J Clin Microbiol 2010; 48 (04) 1231-1240
    CrossrefPubMedSearch in Google Scholar
  • 42 White PL, Barnes RA, Springer J. et al; EAPCRI. Clinical performance of Aspergillus PCR for testing serum and plasma: a Study by the European Aspergillus PCR Initiative. J Clin Microbiol 2015; 53 (09) 2832-2837
    CrossrefPubMedSearch in Google Scholar
  • 43 White PL, Alanio A, Brown L. et al; Fungal PCR Initiative. An overview of using fungal DNA for the diagnosis of invasive mycoses. Expert Rev Mol Diagn 2022; 22 (02) 169-184
    CrossrefPubMedSearch in Google Scholar
  • 44 Barnes RA, White PL, Morton CO. et al. Diagnosis of aspergillosis by PCR: clinical considerations and technical tips. Med Mycol 2018; 56 (Suppl. 01) 60-72
    CrossrefPubMedSearch in Google Scholar
  • 45 Denning DW, Park S, Lass-Florl C. et al. High-frequency triazole resistance found In nonculturable Aspergillus fumigatus from lungs of patients with chronic fungal disease. Clin Infect Dis 2011; 52 (09) 1123-1129
    CrossrefPubMedSearch in Google Scholar
  • 46 Belvoncikova P, Splichalova P, Videnska P, Gardlik R. The human mycobiome: colonization, composition and the role in health and disease. J Fungi (Basel) 2022; 8 (10) 1046
    CrossrefPubMedSearch in Google Scholar
  • 47 Tuon FF. A systematic literature review on the diagnosis of invasive aspergillosis using polymerase chain reaction (PCR) from bronchoalveolar lavage clinical samples. Rev Iberoam Micol 2007; 24 (02) 89-94
    PubMedSearch in Google Scholar
  • 48 Sun W, Wang K, Gao W. et al. Evaluation of PCR on bronchoalveolar lavage fluid for diagnosis of invasive aspergillosis: a bivariate metaanalysis and systematic review. PLoS ONE 2011; 6 (12) e28467
    CrossrefPubMedSearch in Google Scholar
  • 49 Avni T, Levy I, Sprecher H, Yahav D, Leibovici L, Paul M. Diagnostic accuracy of PCR alone compared to galactomannan in bronchoalveolar lavage fluid for diagnosis of invasive pulmonary aspergillosis: a systematic review. J Clin Microbiol 2012; 50 (11) 3652-3658
    CrossrefPubMedSearch in Google Scholar
  • 50 White PL, Mengoli C, Bretagne S. et al; European Aspergillus PCR Initiative (EAPCRI). Evaluation of Aspergillus PCR protocols for testing serum specimens. J Clin Microbiol 2011; 49 (11) 3842-3848
    CrossrefPubMedSearch in Google Scholar
  • 51 Morton CO, White PL, Barnes RA. et al; EAPCRI. Determining the analytical specificity of PCR-based assays for the diagnosis of IA: what is Aspergillus?. Med Mycol 2017; 55 (04) 402-413
    PubMedSearch in Google Scholar
  • 52 Arvanitis M, Ziakas PD, Zacharioudakis IM, Zervou FN, Caliendo AM, Mylonakis E. PCR in diagnosis of invasive aspergillosis: a meta-analysis of diagnostic performance. J Clin Microbiol 2014; 52 (10) 3731-3742
    CrossrefPubMedSearch in Google Scholar
  • 53 Cruciani M, Mengoli C, Barnes R. et al. Polymerase chain reaction blood tests for the diagnosis of invasive aspergillosis in immunocompromised people. Cochrane Database Syst Rev 2019; 9 (09) CD009551
    PubMedSearch in Google Scholar
  • 54 Cruciani M, White PL, Mengoli C. et al; Fungal PCR Initiative. The impact of anti-mould prophylaxis on Aspergillus PCR blood testing for the diagnosis of invasive aspergillosis. J Antimicrob Chemother 2021; 76 (03) 635-638
    CrossrefPubMedSearch in Google Scholar
  • 55 Huygens S, Dunbar A, Buil JB. et al. Clinical impact of PCR-based Aspergillus and azole resistance detection in invasive aspergillosis. A prospective multicenter study. Clin Infect Dis 2023; 77 (01) 38-45
    CrossrefPubMedSearch in Google Scholar
  • 56 American Society for Microbiology. Metagenomic Next Generation Sequencing: How Does It Work and Is It Coming to Your Clinical Microbiology Lab?. Available from: https://asm.org:443/Articles/2019/November/Metagenomic-Next-Generation-Sequencing-How-Does-It . Accessed August 8, 2023
    PubMed
  • 57 Karius. Karius Test. Available from: https://kariusdx.com/karius-test
    PubMed
  • 58 Armstrong AE, Rossoff J, Hollemon D, Hong DK, Muller WJ, Chaudhury S. Cell-free DNA next-generation sequencing successfully detects infectious pathogens in pediatric oncology and hematopoietic stem cell transplant patients at risk for invasive fungal disease. Pediatr Blood Cancer 2019; 66 (07) e27734
    CrossrefPubMedSearch in Google Scholar
  • 59 Heldman MR, Ahmed AA, Liu W. et al. Serial quantitation of plasma microbial cell-free DNA before and after diagnosis of pulmonary invasive mold infections in hematopoietic cell transplant recipients. J Infect Dis 2023; jiad255
    CrossrefPubMedSearch in Google Scholar
  • 60 Hoenigl M, Egger M, Price J, Krause R, Prattes J, White PL. Metagenomic next-generation sequencing of plasma for diagnosis of COVID-19-associated pulmonary aspergillosis. J Clin Microbiol 2023; 61 (03) e0185922
    CrossrefPubMedSearch in Google Scholar
  • 61 Hogan CA, Yang S, Garner OB. et al. Clinical impact of metagenomic next-generation sequencing of plasma cell-free DNA for the diagnosis of infectious diseases: a multicenter retrospective cohort study. Clin Infect Dis 2021; 72 (02) 239-245
    CrossrefPubMedSearch in Google Scholar
  • 62 Wilson MR, Sample HA, Zorn KC. et al. Clinical metagenomic sequencing for diagnosis of meningitis and encephalitis. N Engl J Med 2019; 380 (24) 2327-2340
    CrossrefPubMedSearch in Google Scholar
  • 63 Mah J, Nicholas V, Tayyar R. et al. Superior accuracy of Aspergillus plasma cell-free DNA PCR over serum galactomannan for the diagnosis of invasive aspergillosis. Clin Infect Dis 2023; ciad420
    PubMedSearch in Google Scholar
  • 64 Fens N, Zwinderman AH, van der Schee MP. et al. Exhaled breath profiling enables discrimination of chronic obstructive pulmonary disease and asthma. Am J Respir Crit Care Med 2009; 180 (11) 1076-1082
    CrossrefPubMedSearch in Google Scholar
  • 65 Chung J, Akter S, Han S. et al. Diagnosis by volatile organic compounds in exhaled breath in exhaled breath from patients with gastric and colorectal cancers. Int J Mol Sci 2022; 24 (01) 129
    CrossrefPubMedSearch in Google Scholar
  • 66 de Heer K, van der Schee MP, Zwinderman K. et al. Electronic nose technology for detection of invasive pulmonary aspergillosis in prolonged chemotherapy-induced neutropenia: a proof-of-principle study. J Clin Microbiol 2013; 51 (05) 1490-1495
    CrossrefPubMedSearch in Google Scholar
  • 67 Gerritsen MG, Brinkman P, Escobar N. et al. Profiling of volatile organic compounds produced by clinical Aspergillus isolates using gas chromatography-mass spectrometry. Med Mycol 2018; 56 (02) 253-256
    CrossrefPubMedSearch in Google Scholar
  • 68 Sweeney TE, Shidham A, Wong HR, Khatri P. A comprehensive time-course-based multicohort analysis of sepsis and sterile inflammation reveals a robust diagnostic gene set. Sci Transl Med 2015; 7 (287) 287ra71
    CrossrefPubMedSearch in Google Scholar
  • 69 Cheemarla NR, Hanron A, Fauver JR. et al. Nasal host response-based screening for undiagnosed respiratory viruses: a pathogen surveillance and detection study. Lancet Microbe 2023; 4 (01) e38-e46
    CrossrefPubMedSearch in Google Scholar
  • 70 Lydon EC, Henao R, Burke TW. et al. Validation of a host response test to distinguish bacterial and viral respiratory infection. EBioMedicine 2019; 48: 453-461
    CrossrefPubMedSearch in Google Scholar
  • 71 Ng DL, Granados AC, Santos YA. et al. A diagnostic host response biosignature for COVID-19 from RNA profiling of nasal swabs and blood. Sci Adv 2021; 7 (06) eabe5984
    CrossrefPubMedSearch in Google Scholar
  • 72 Li H, Liu L, Zhou W. et al. Pentraxin 3 in bronchoalveolar lavage fluid and plasma in non-neutropenic patients with pulmonary aspergillosis. Clin Microbiol Infect 2019; 25 (04) 504-510
    CrossrefPubMedSearch in Google Scholar
  • 73 Kabbani D, Bhaskaran A, Singer LG. et al. Pentraxin 3 levels in bronchoalveolar lavage fluid of lung transplant recipients with invasive aspergillosis. J Heart Lung Transplant 2017; 36 (09) 973-979
    CrossrefPubMedSearch in Google Scholar
  • 74 Dobiáš R, Jaworská P, Skopelidou V. et al. Distinguishing invasive from chronic pulmonary infections: host Pentraxin 3 and fungal siderophores in bronchoalveolar lavage fluids. J Fungi (Basel) 2022; 8 (11) 1194
    CrossrefPubMedSearch in Google Scholar
  • 75 Dix A, Czakai K, Springer J. et al. Genome-wide expression profiling reveals S100B as biomarker for invasive aspergillosis. Front Microbiol 2016; 7: 320
    PubMedSearch in Google Scholar
  • 76 Gonçalves SM, Lagrou K, Rodrigues CS. et al. Evaluation of bronchoalveolar lavage fluid cytokines as biomarkers for invasive pulmonary aspergillosis in at-risk patients. Front Microbiol 2017; 8: 2362 https://www.frontiersin.org/articles/10.3389/fmicb.2017.02362 . Accessed August 8, 2023
    CrossrefPubMedSearch in Google Scholar
  • 77 Becker KL, Ifrim DC, Quintin J, Netea MG, van de Veerdonk FL. Antifungal innate immunity: recognition and inflammatory networks. Semin Immunopathol 2015; 37 (02) 107-116
    CrossrefPubMedSearch in Google Scholar
  • 78 Heldt S, Prattes J, Eigl S. et al. Diagnosis of invasive aspergillosis in hematological malignancy patients: performance of cytokines, Asp LFD, and Aspergillus PCR in same day blood and bronchoalveolar lavage samples. J Infect 2018; 77 (03) 235-241
    CrossrefPubMedSearch in Google Scholar
  • 79 Hérivaux A, Willis JR, Mercier T. et al. Lung microbiota predict invasive pulmonary aspergillosis and its outcome in immunocompromised patients. Thorax 2022; 77 (03) 283-291
    CrossrefPubMedSearch in Google Scholar
  • 80 Feys S, Gonçalves SM, Khan M. et al. Lung epithelial and myeloid innate immunity in influenza-associated or COVID-19-associated pulmonary aspergillosis: an observational study. Lancet Respir Med 2022; 10 (12) 1147-1159
    CrossrefPubMedSearch in Google Scholar
  • 81 Ergün M, Brüggemann RJM, Alanio A. et al. Aspergillus test profiles and mortality in critically ill COVID-19 patients. J Clin Microbiol 2021; 59 (12) e0122921
    CrossrefPubMedSearch in Google Scholar
  • 82 Mercier T, Wera J, Chai LYA, Lagrou K, Maertens J. A mortality prediction rule for hematology patients with invasive aspergillosis based on serum galactomannan kinetics. J Clin Med 2020; 9 (02) 610
    CrossrefPubMedSearch in Google Scholar
  • 83 Lamberink H, Wagemakers A, Sigaloff KCE, van Houdt R, de Jonge NA, van Dijk K. The impact of the updated EORTC/MSG criteria on the classification of hematological patients with suspected invasive pulmonary aspergillosis. Clin Microbiol Infect 2022; 28 (08) 1120-1125
    CrossrefPubMedSearch in Google Scholar
  • 84 Maertens J, Lodewyck T, Peter Donnelly J. et al. Empiric versus pre-emptive antifungal strategy in high-risk neutropenic patients on fluconazole prophylaxis: a randomized trial of the European organization for Research and Treatment of cancer (EORTC 65091). Clin Infect Dis 2023; 76 (04) 674-682
    CrossrefPubMedSearch in Google Scholar
  • 85 Verweij PE, Rijnders BJA, Brüggemann RJM. et al. Review of influenza-associated pulmonary aspergillosis in ICU patients and proposal for a case definition: an expert opinion. Intensive Care Med 2020; 46 (08) 1524-1535
    CrossrefPubMedSearch in Google Scholar
  • 86 Koehler P, Bassetti M, Chakrabarti A. et al; European Confederation of Medical Mycology, International Society for Human Animal Mycology, Asia Fungal Working Group, INFOCUS LATAM/ISHAM Working Group, ISHAM Pan Africa Mycology Working Group, European Society for Clinical Microbiology, Infectious Diseases Fungal Infection Study Group, ESCMID Study Group for Infections in Critically Ill Patients, Interregional Association of Clinical Microbiology and Antimicrobial Chemotherapy, Medical Mycology Society of Nigeria, Medical Mycology Society of China Medicine Education Association, Infectious Diseases Working Party of the German Society for Haematology and Medical Oncology, Association of Medical Microbiology, Infectious Disease Canada. Defining and managing COVID-19-associated pulmonary aspergillosis: the 2020 ECMM/ISHAM consensus criteria for research and clinical guidance. Lancet Infect Dis 2021; 21 (06) e149-e162
    CrossrefPubMedSearch in Google Scholar
  • 87 Roman-Montes CM, Martinez-Gamboa A, Diaz-Lomelí P. et al. Accuracy of galactomannan testing on tracheal aspirates in COVID-19-associated pulmonary aspergillosis. Mycoses 2021; 64 (04) 364-371
    CrossrefPubMedSearch in Google Scholar
  • 88 Verweij PE, Brüggemann RJM, Azoulay E. et al. Taskforce report on the diagnosis and clinical management of COVID-19 associated pulmonary aspergillosis. Intensive Care Med 2021; 47 (08) 819-834
    CrossrefPubMedSearch in Google Scholar
  • 89 Feys S, Almyroudi MP, Braspenning R. et al. A visual and comprehensive review on COVID-19-associated pulmonary aspergillosis (CAPA). J Fungi (Basel) 2021; 7 (12) 1067
    CrossrefPubMedSearch in Google Scholar
  • 90 Schauwvlieghe AFAD, Rijnders BJA, Philips N. et al; Dutch-Belgian Mycosis study group. Invasive aspergillosis in patients admitted to the intensive care unit with severe influenza: a retrospective cohort study. Lancet Respir Med 2018; 6 (10) 782-792
    CrossrefPubMedSearch in Google Scholar
  • 91 Lass-Flörl C, Knoll M, Posch W. et al. A laboratory-based study on multiple biomarker testing in the diagnosis of COVID-19-associated pulmonary aspergillosis (CAPA): real-life data. Diagnostics (Basel) 2022; 13 (01) 114
    CrossrefPubMedSearch in Google Scholar
  • 92 Hoenigl M, Egger M, Boyer J, Schulz E, Prattes J, Jenks JD. serum lateral flow assay with digital reader for the diagnosis of invasive pulmonary aspergillosis: a two-centre mixed cohort study. Mycoses 2021; 64 (10) 1197-1202
    CrossrefPubMedSearch in Google Scholar
  • 93 Serin I, Baltali S, Cinli TA, Goze H, Demir B, Yokus O. Lateral flow assay (LFA) in the diagnosis of COVID-19-associated pulmonary aspergillosis (CAPA): a single-center experience. BMC Infect Dis 2022; 22 (01) 822
    CrossrefPubMedSearch in Google Scholar
  • 94 Giusiano G, Fernández NB, Vitale RG. et al. Usefulness of Sōna Aspergillus Galactomannan LFA with digital readout as diagnostic and as screening tool of COVID-19 associated pulmonary aspergillosis in critically ill patients. Data from a multicenter prospective study performed in Argentina. Med Mycol 2022; 60 (05) myac026
    CrossrefPubMedSearch in Google Scholar
  • 95 Ghazanfari M, Yazdani Charati J, Davoodi L. et al. Comparative analysis of galactomannan lateral flow assay, galactomannan enzyme immunoassay and BAL culture for diagnosis of COVID-19-associated pulmonary aspergillosis. Mycoses 2022; 65 (10) 960-968
    CrossrefPubMedSearch in Google Scholar
  • 96 Kanj A, Abdallah N, Soubani AO. The spectrum of pulmonary aspergillosis. Respir Med 2018; 141: 121-131
    CrossrefPubMedSearch in Google Scholar
  • 97 Uffredi ML, Mangiapan G, Cadranel J, Kac G. Significance of Aspergillus fumigatus isolation from respiratory specimens of nongranulocytopenic patients. Eur J Clin Microbiol Infect Dis 2003; 22 (08) 457-462
    CrossrefPubMedSearch in Google Scholar
  • 98 Sehgal IS, Dhooria S, Choudhary H. et al. Utility of serum and bronchoalveolar lavage fluid galactomannan in diagnosis of chronic pulmonary aspergillosis. J Clin Microbiol 2019; 57 (03) e01821-e18
    CrossrefPubMedSearch in Google Scholar
  • 99 Wilopo BAP, Richardson MD, Denning DW. Diagnostic aspects of chronic pulmonary aspergillosis: present and new directions. Curr Fungal Infect Rep 2019; 13 (04) 292-300
    CrossrefPubMedSearch in Google Scholar
  • 100 Richardson M, Page I. Role of serological tests in the diagnosis of mold infections. Curr Fungal Infect Rep 2018; 12 (03) 127-136
    CrossrefPubMedSearch in Google Scholar
  • 101 Stucky Hunter E, Richardson MD, Denning DW. Evaluation of LDBio Aspergillus ICT lateral flow assay for IgG and IgM antibody detection in chronic pulmonary aspergillosis. J Clin Microbiol 2019; 57 (09) e00538-e19
    CrossrefPubMedSearch in Google Scholar
  • 102 Hunter ES, Page ID, Richardson MD, Denning DW. Evaluation of the LDBio Aspergillus ICT lateral flow assay for serodiagnosis of allergic bronchopulmonary aspergillosis. PLoS ONE 2020; 15 (09) e0238855
    CrossrefPubMedSearch in Google Scholar
  • 103 Kwizera R, Bongomin F, Olum R. et al. Evaluation of an Aspergillus IgG/IgM lateral flow assay for serodiagnosis of fungal asthma in Uganda. PLoS ONE 2021; 16 (05) e0252553
    CrossrefPubMedSearch in Google Scholar
  • 104 Lass-Flörl C, Salzer GM, Schmid T, Rabl W, Ulmer H, Dierichi MP. Pulmonary Aspergillus colonization in humans and its impact on management of critically ill patients. Br J Haematol 1999; 104 (04) 745-747
    CrossrefPubMedSearch in Google Scholar
  • 105 Shin B, Koh W-J, Jeong B-H. et al. Serum galactomannan antigen test for the diagnosis of chronic pulmonary aspergillosis. J Infect 2014; 68 (05) 494-499
    CrossrefPubMedSearch in Google Scholar
  • 106 Kono Y, Tsushima K, Yamaguchi K. et al. The utility of galactomannan antigen in the bronchial washing and serum for diagnosing pulmonary aspergillosis. Respir Med 2013; 107 (07) 1094-1100
    CrossrefPubMedSearch in Google Scholar
  • 107 de Oliveira VF, Silva GD, Taborda M, Levin AS, Magri MMC. Systematic review and meta-analysis of galactomannan antigen testing in serum and bronchoalveolar lavage for the diagnosis of chronic pulmonary aspergillosis: defining a cutoff. Eur J Clin Microbiol Infect Dis 2023; 42 (09) 1047-1054
    CrossrefPubMedSearch in Google Scholar
  • 108 Salzer HJF, Prattes J, Flick H. et al. Evaluation of galactomannan testing, the Aspergillus-specific lateral-flow device test and levels of cytokines in bronchoalveolar lavage fluid for diagnosis of chronic pulmonary aspergillosis. Front Microbiol 2018; 9: 2223
    CrossrefPubMedSearch in Google Scholar
  • 109 Takazono T, Ito Y, Tashiro M. et al. Evaluation of Aspergillus-specific lateral-flow device test using serum and bronchoalveolar lavage fluid for diagnosis of chronic pulmonary aspergillosis. J Clin Microbiol 2019; 57 (05) e00095-e19
    CrossrefPubMedSearch in Google Scholar