Point-of-care testing for viral-associated pulmonary aspergillosis

ABSTRACT

Introduction

Over the last years, severe respiratory viral infections, particularly those caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the influenza virus, have emerged as risk factor for viral-associated pulmonary aspergillosis (VAPA) among critically ill patients. Delays in diagnosis of VAPA are associated with increased mortality. Point-of-care-tests may play an important role in earlier diagnosis of VAPA and thus improve patient outcomes.

Areas covered

The following review will give an update on point-of-care tests for VAPA, analyzing performances in respiratory and blood specimens.

Expert opinion

Point-of-care tests have emerged, and particularly the IMMY Aspergillus galactomannan lateral flow assay (LFA) shows performances comparable to the galactomannan ELISA for diagnosis of VAPA. Notably, nearly all evaluations of POC tests for VAPA have been performed in COVID-19 patients, with very limited data in influenza patients. For early diagnosis of COVID associated pulmonary aspergillosis (CAPA), the LFA has shown promising performances in respiratory samples, particularly in bronchoalveolar lavage fluid, and may thereby help in improving patient outcomes. In contrast, serum LFA testing may not be useful for early diagnosis of disease, except in cases with invasive tracheobronchial aspergillosis.

KEYWORDS:

• Lateral flow device test
• lateral flow assay
• non-neutropenic
• ICU
• COVID
• influenza
• pulmonary aspergillosis
• Aspergillus

Article highlights

• Early diagnosis from samples of the lower respiratory tract and treatment of invasive aspergillosis is an important predictor of survival in patients with VAPA.

• Conventional culture and – to a lesser extent – galactomannan testing are limited by long processing times in some settings.

• Point-of-care diagnostic tests for invasive aspergillosis (IA) are now commercially available and will complement GM and culture in diagnosis of VAPA.

• Particularly, the IMMY LFA has shown promise for diagnosis of CAPA, while data on other POC tests are limited to non-existing.

• Serum testing with POCT has shown limited sensitivity for early diagnosis of VAPA.

• Data on diagnostic performance of POCT for IAPA are very limited.

Declaration of interests

RA, BA, MG: No conflicts of interest. JP has received research funding from MSD and Pfizer and lecture honoraria from Gilead Sciences, Pfizer, Associates of Cape Cod and Swedish Orphan Biovitrium GmbH, outside of the submitted work. KL: Received consultancy fees from MRM Health and MSD, speaker fees from Pfizer and Gilead and a service fee from Thermo fisher Scientific and TECOmedical. JPG: Received speaker fees from Gilead, Mundipharma and Pfizer. MH: Received grants and research funding and personal fees from Astellas, Gilead, MSD, Pfizer, Euroimmun, F2G, Pulmocide, IMMY, Mundipharma and Scynexis. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.