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Published on: March 22, 2012
Aspergillus antigen testing in bone marrow transplant recipients
E C Williamson1, D A Oliver, E M Johnson
1Public Health Laboratory, Bristol Royal Infirmary, UK.
Journal of Clinical Pathology
|July 13, 2000
Summary
The aspergillus antigen enzyme linked immunosorbent assay (ELISA) is specific for invasive aspergillosis (IA) diagnosis in bone marrow transplant recipients when two positive results are required. However, it is not sensitive enough for early detection in asymptomatic patients.
Area of Science:
- Medical Mycology
- Transplant Immunology
- Diagnostic Microbiology
Background:
- Invasive aspergillosis (IA) poses a significant threat to immunocompromised patients, particularly bone marrow transplant (BMT) recipients.
- Early and accurate diagnosis of IA is crucial for timely therapeutic intervention and improved patient outcomes.
- Current diagnostic methods have limitations in sensitivity and specificity, necessitating the evaluation of novel diagnostic tools.
Purpose of the Study:
- To evaluate the clinical utility of a commercial aspergillus antigen enzyme linked immunosorbent assay (ELISA) for diagnosing IA in BMT recipients.
- To compare the performance of the aspergillus antigen ELISA with a commercial latex agglutination (LA) test in the same patient population.
Main Methods:
- A retrospective analysis of 2026 serum samples from 104 BMT recipients was conducted.
- Samples were tested using both a commercial aspergillus antigen ELISA and a commercial latex agglutination (LA) test.
- Patient groups included those with confirmed IA, suspected IA, and no signs of IA.
Main Results:
- The aspergillus antigen ELISA demonstrated higher sensitivity compared to the LA test.
- A positive ELISA result was always accompanied by a positive LA result; positive LA results never preceded positive ELISA results.
- ELISA detected Aspergillus antigen a median of 15 days before death in patients with IA, but was not solely used for initiating antifungal treatment due to two false positive results in non-IA patients.
Conclusions:
- The aspergillus antigen ELISA is a specific diagnostic marker for IA in BMT recipients when a criterion of two positive samples is applied.
- The test's sensitivity is insufficient for diagnosing IA before other clinical signs emerge, limiting its utility for early antifungal treatment initiation in asymptomatic individuals.
- The ELISA is valuable for confirming IA in symptomatic patients but unsuitable for screening asymptomatic, at-risk individuals.
