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Diagnostic Performance of Sōna GM LFA in Pulmonary Infections Caused by Different Aspergillus Species
Manuela Loaiza-Oliva1,2, Paula Funes3, María Mercedes Romero3
1Laboratorio de Micología y Diagnóstico Molecular-Cátedra de Parasitología y Micología-Facultad de Bioquímica, Universidad Nacional del Litoral, Santa Fe, Argentina.
Background:
Although Aspergillus fumigatus remains the primary cause of invasive aspergillosis, other species-including emerging cryptic ones-are increasingly identified in clinical settings. These species often exhibit distinct antifungal susceptibility profiles, emphasising the importance of species-level identification for effective patient management. Galactomannan, once considered specific to A. fumigatus, is now widely used for aspergillosis diagnosis regardless of species. However, its performance in detecting non-fumigatus infections remains insufficiently characterised.
Objective:
To evaluate the diagnostic performance of the Sōna GM LFA (IMMY) in BAL samples from patients with pulmonary infections attributed to different Aspergillus spp., including cryptic species.
Methods:
We evaluated the diagnostic performance of the Sōna galactomannan LFA (IMMY) in bronchoalveolar lavage samples from 49 patients (15% paediatric) with probable invasive aspergillosis or COVID-associated pulmonary aspergillosis, confirmed by microscopy and culture.
Results:
The etiologic agents comprised A. fumigatus sensu stricto (46.9%), A. terreus ss. (16.3%), A. flavus ss. (16.3%), A. niger ss. (6.1%), A. nidulans (4.1%) and five cryptic species (10.2%). Galactomannan index values varied across species and clinical group, with particularly low readings (0.09-0.31) in six cases (five involving cryptic species), suggesting reduced assay sensitivity for cryptic taxa. Paediatric samples also showed lower galactomannan levels compared to adults.
Conclusions:
This study highlights the limitations of galactomannan assays in detecting cryptic Aspergillus infections, showing consistently low galactomannan levels in BAL. Multicenter studies are needed to validate findings and refine clinical algorithms.
Insights
Galactomannan assays show reduced sensitivity for diagnosing invasive aspergillosis caused by cryptic Aspergillus species. Further multicenter studies are needed to refine diagnostic algorithms for these challenging infections.
Area of Science:
- Clinical Mycology
- Diagnostic Microbiology
- Infectious Diseases
Background:
- Invasive aspergillosis is primarily caused by Aspergillus fumigatus, but other species, including cryptic ones, are increasingly identified.
- Accurate species-level identification is crucial due to varying antifungal susceptibility profiles.
- Galactomannan assays are widely used for aspergillosis diagnosis but their performance against non-fumigatus species requires further characterization.
Purpose of the Study:
- To evaluate the diagnostic performance of the Sōna galactomannan lateral flow assay (LFA) in bronchoalveolar lavage (BAL) samples.
- To assess the assay's effectiveness in detecting pulmonary infections caused by various Aspergillus species, including cryptic species.
Main Methods:
- Diagnostic performance of the Sōna galactomannan LFA was evaluated using BAL samples from 49 patients.
- Patients had probable invasive aspergillosis or COVID-associated pulmonary aspergillosis, confirmed by microscopy and culture.
- Samples included a spectrum of Aspergillus species, with species identification confirmed through culture and other methods.
Main Results:
- The study identified Aspergillus fumigatus (46.9%), A. terreus (16.3%), A. flavus (16.3%), A. niger (6.1%), A. nidulans (4.1%), and five cryptic species (10.2%).
- Lower galactomannan index values (0.09-0.31) were observed in six cases, particularly those involving cryptic species, indicating reduced assay sensitivity.
- Paediatric samples generally showed lower galactomannan levels compared to adult samples.
Conclusions:
- Galactomannan assays demonstrate limitations in detecting infections caused by cryptic Aspergillus species due to consistently low galactomannan levels in BAL samples.
- Further multicenter studies are essential to validate these findings and develop improved clinical algorithms for diagnosing invasive aspergillosis.
- Species-level identification remains critical for accurate diagnosis and appropriate patient management of invasive aspergillosis.
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