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Updated: May 3, 2026
Detection of Invasive Pulmonary Aspergillosis in Haematological Malignancy Patients by using Lateral-flow Technology
Published on: March 22, 2012
Performance of Galactomannan, Aspergillus-PCR, and Metagenomic sequencing for the diagnosis of invasive pulmonary
Chun-Hui Xu1, Li-Ning Zhang2, Teng Liu3
1State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020, China; Tianjin Institutes of Health Science, Tianjin, 301600, China; Microbiology laboratory, Tianjin Union Precision Medical Diagnostic Co., Ltd, Tianjin, 301617, China.
Background/Purpose(S):
Invasive pulmonary aspergillosis (IPA) is a serious fungal infection, and its diagnosis is diverse, especially in patients with hematological disorders. This study aims to determine the optimal diagnostic strategy for IPA in such patients by comparing various microbiological tests.
Methods:
A total of 490 blood and 138 bronchoalveolar lavage fluid (BALF) samples collected from 182 IPA and 407 no-IPA patients (based on EORTC/MSGERC criteria) were retrospectively analyzed by metagenomic next-generation sequencing (mNGS), Aspergillus-PCR, and galactomannan (GM) (enzyme immunoassay [EIA] and lateral flow assay [LFA]).
Results:
In BALF samples, GM-EIA, GM-LFA, Aspergillus-PCR, and mNGS showed sensitivities of 68.1 %, 53.2 %, 83.0 %, and 59.6 %-all higher than in blood (43.7 %, 34.4 %, 51.7 %, 55.0 %). In blood samples, mNGS had the highest sensitivity (71.9 %) in neutropenic patients, which was further improved when combined with GM-EIA (77.1 %). In non-neutropenic patients, Aspergillus-PCR was the most sensitive assay (47.3 %), with sensitivity improving to 56.4 % when combined with GM-EIA. Blood test sensitivities were lower in patients with prolonged antifungal therapy (≥7 days) vs. <7 days (Aspergillus-PCR: 38.6 % vs. 57.0 %; mNGS: 31.8 % vs. 64.5 %; GM-EIA: 27.3 % vs. 50.5 %; all P < 0.05), with no impact on BALF results.
Conclusion:
BALF is critical for accurate IPA diagnosis, particularly in patients with prior antifungal therapy. BALF Aspergillus-PCR offers optimal sensitivity, while blood-based mNGS and PCR are recommended for neutropenic and non-neutropenic patients, respectively. Combining molecular methods with GM testing enhances diagnostic performances. Tailored strategies are essential to improve early detection and clinical outcomes in high-risk hematologic populations.
Insights
Bronchoalveolar lavage fluid (BALF) testing is crucial for diagnosing invasive pulmonary aspergillosis (IPA), especially after antifungal therapy. Aspergillus-PCR in BALF provides the best sensitivity for IPA detection in hematologic patients.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Hematology
Background:
- Invasive pulmonary aspergillosis (IPA) presents diagnostic challenges in hematologic patients.
- Accurate and timely diagnosis is critical for effective treatment and improved outcomes.
Purpose of the Study:
- To compare the diagnostic performance of various microbiological tests for IPA in patients with hematologic disorders.
- To determine the optimal diagnostic strategy for IPA in this high-risk population.
Main Methods:
- Retrospective analysis of blood and bronchoalveolar lavage fluid (BALF) samples from IPA and no-IPA patients.
- Utilized metagenomic next-generation sequencing (mNGS), Aspergillus-PCR, and galactomannan (GM) testing (EIA and LFA).
- Patient classification based on EORTC/MSGERC criteria.
Main Results:
- BALF samples demonstrated higher sensitivity for all tested methods compared to blood samples.
- In neutropenic patients, blood mNGS combined with GM-EIA showed highest sensitivity (77.1%).
- In non-neutropenic patients, blood Aspergillus-PCR combined with GM-EIA yielded the highest sensitivity (56.4%).
- Prolonged antifungal therapy significantly reduced blood test sensitivity.
Conclusions:
- BALF analysis, particularly Aspergillus-PCR, is essential for IPA diagnosis, especially with prior antifungal exposure.
- Blood-based mNGS and PCR are recommended for neutropenic and non-neutropenic patients, respectively.
- Combining molecular methods with GM testing improves diagnostic accuracy, necessitating tailored strategies for early IPA detection in hematologic patients.
