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Updated: Aug 9, 2025
Detection of Invasive Pulmonary Aspergillosis in Haematological Malignancy Patients by using Lateral-flow Technology
Published on: March 22, 2012
Invasive Pulmonary Aspergillosis
Marie-Pierre Ledoux1, Raoul Herbrecht1
1Department of Hematology, Institut de Cancérologie de Strasbourg Europe (ICANS), 67033 Strasbourg, France.
Abstract:
Invasive pulmonary aspergillosis is growing in incidence, as patients at risk are growing in diversity. Outside the classical context of neutropenia, new risk factors are emerging or newly identified, such as new anticancer drugs, viral pneumonias and hepatic dysfunctions. Clinical signs remain unspecific in these populations and the diagnostic work-up has considerably expanded. Computed tomography is key to assess the pulmonary lesions of aspergillosis, whose various features must be acknowledged. Positron-emission tomography can bring additional information for diagnosis and follow-up. The mycological argument for diagnosis is rarely fully conclusive, as biopsy from a sterile site is challenging in most clinical contexts. In patients with a risk and suggestive radiological findings, probable invasive aspergillosis is diagnosed through blood and bronchoalveolar lavage fluid samples by detecting galactomannan or DNA, or by direct microscopy and culture for the latter. Diagnosis is considered possible with mold infection in lack of mycological criterion. Nevertheless, the therapeutic decision should not be hindered by these research-oriented categories, that have been completed by better adapted ones in specific settings. Survival has been improved over the past decades with the development of relevant antifungals, including lipid formulations of amphotericin B and new azoles. New antifungals, including first-in-class molecules, are awaited.
Insights
Invasive pulmonary aspergillosis is increasingly diagnosed in diverse patient groups beyond neutropenia. Early detection via imaging and biomarkers, alongside new antifungals, improves survival for this serious fungal infection.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Pulmonology
Background:
- Invasive pulmonary aspergillosis (IPA) incidence is rising.
- Risk factors are expanding beyond neutropenia to include new anticancer drugs, viral pneumonias, and hepatic dysfunction.
- Classical clinical signs are often unspecific in at-risk populations.
Purpose of the Study:
- To review the evolving landscape of IPA diagnosis and management.
- To highlight advances in diagnostic work-up and therapeutic strategies.
- To emphasize the importance of recognizing new risk factors and diagnostic tools.
Main Methods:
- Review of current literature and diagnostic guidelines for IPA.
- Analysis of imaging techniques (CT, PET) in diagnosing pulmonary lesions.
- Evaluation of mycological diagnostic arguments, including biomarkers (galactomannan, DNA) and direct methods.
- Discussion of therapeutic advancements and future antifungal development.
Main Results:
- Computed tomography (CT) is crucial for assessing pulmonary lesions, requiring acknowledgment of varied features.
- Positron-emission tomography (PET) offers supplementary diagnostic and follow-up information.
- Diagnosis of probable IPA relies on risk factors, suggestive radiology, and detection of biomarkers (galactomannan, DNA) or direct evidence in blood and bronchoalveolar lavage fluid.
- Mycological confirmation can be challenging due to difficulties in obtaining sterile site biopsies.
Conclusions:
- IPA diagnosis requires a comprehensive approach integrating clinical, radiological, and microbiological data, especially in non-neutropenic patients.
- Improved diagnostic strategies and newer antifungal agents have enhanced patient survival.
- Ongoing research into novel antifungals is critical for managing this opportunistic infection.
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