Invasive pulmonary aspergillosis (IPA)- A study of risk factors, diagnostic modalities and role of galactomannan antigen detection

IF 1.5 4区医学 Q4 IMMUNOLOGY

Indian Journal of Medical Microbiology Pub Date : 2025-11-01 Epub Date: 2025-09-27 DOI:10.1016/j.ijmmb.2025.100982

Mani Bhushan Pant , Rajender Singh , Garima Mittal , Rakhee Khanduri

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引用次数: 0

Abstract

Introduction

Pulmonary invasive fungal infections (IFIs), particularly among immunocompromised individuals, are associated with substantial morbidity and mortality. This study aimed to evaluate the clinical profile, underlying risk factors, and diagnostic performance of the galactomannan (GM) antigen assay in the diagnosis of Invasive Pulmonary Aspergillosis (IPA).

Material and methods

A cross-sectional observational study was conducted over 12 months at the Himalayan Institute of Medical Sciences, Dehradun, India. A total of 224 patients with suspected pulmonary IFIs were enrolled. Cases were classified as Proven, Probable, Possible, or No IFI based on the EORTC/MSG, Invasive Fungal Diseases in Adult Patients in Intensive Care Unit (FUNDICU) criteria. Respiratory and serum samples were analysed using direct potassium hydroxide (KOH) microscopy, fungal culture, and GM antigen detection via lateral flow assay. Diagnostic accuracy was determined using standard statistical analyses.

Results

Of the 224 patients, 46.4 % were classified as Proven or Probable IFI, 34.8 % as Possible, and 18.8 % as No IFI. dyspnoea (p = 0.002) was the most strongly associated symptom. Significant risk factors included asthma/COPD (52.9 %, p = 0.001), diabetes mellitus (36.5 %, p = 0.028), immunosuppression (37.5 %, p < 0.001). Fungal culture was positive in 30.3 % of cases, with Aspergillus flavus and A. fumigatus as the predominant isolates. A bronchoalveolar lavage fluid (BALF) GM optical density index (ODI) cut-off of ≥1.0 achieved balanced sensitivity (55.56 %) and specificity (75.86 %).

Conclusions

The GM assay in BALF at an ODI threshold of ≥1.0 showsmodest discriminative ability for the early detection of invasive pulmonary aspergillosis (IPA). Incorporating GM testing alongside conventional diagnostics enhances early identification and facilitates prompt antifungal therapy.

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侵袭性肺曲霉病（IPA）——半乳甘露聚糖抗原检测的危险因素、诊断方式和作用的研究。

肺侵袭性真菌感染（IFIs），特别是在免疫功能低下的个体中，与大量发病率和死亡率相关。本研究旨在评估半乳甘露聚糖（GM）抗原测定在诊断侵袭性肺曲霉病（IPA）中的临床特征、潜在危险因素和诊断性能。材料和方法：在印度德拉敦喜马拉雅医学科学研究所进行了一项为期12个月的横断面观察研究。共纳入224例疑似肺部ifi患者。根据EORTC/MSG，重症监护病房成人患者侵袭性真菌疾病（FUNDICU）标准，将病例分为确诊、可能、可能或无IFI。呼吸道和血清样本分析采用直接氢氧化钾（KOH）显微镜，真菌培养和GM抗原检测通过横向流动试验。采用标准统计分析确定诊断准确性。结果：224例患者中，46.4%为确诊或可能IFI， 34.8%为可能IFI， 18.8%为无IFI。呼吸困难（p=0.002）是相关性最强的症状。显著危险因素包括哮喘/COPD （52.9%, p=0.001）、糖尿病（36.5%,p=0.028）、免疫抑制（37.5%）。结论：ODI阈值≥1.0时，BALF GM检测对侵袭性肺曲霉病（IPA）的早期诊断具有一定的鉴别能力。将转基因检测与常规诊断结合起来，可以提高早期识别能力，促进及时的抗真菌治疗。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Indian Journal of Medical Microbiology IMMUNOLOGY-

CiteScore

2.20

自引率

0.00%

发文量

154

审稿时长

73 days

期刊介绍： Manuscripts of high standard in the form of original research, multicentric studies, meta analysis, are accepted. Current reports can be submitted as brief communications. Case reports must include review of current literature, clinical details, outcome and follow up. Letters to the editor must be a comment on or pertain to a manuscript already published in the IJMM or in relation to preliminary communication of a larger study. Review articles, Special Articles or Guest Editorials are accepted on invitation.