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Diagnostic performance of Aspergillus-specific immunoglobulin G immunochromatographic and enzyme-linked immunosorbent assay testing in chronic pulmonary aspergillosis: comparative analysis across subtypes and influencing factors

Summary

Chronic pulmonary aspergillosis is a serious fungal lung infection that often develops after tuberculosis. This study compared two blood tests for diagnosing this disease: a quick point-of-care test and a traditional lab test. The quick test performed better overall and could be used in areas without advanced laboratory equipment, though previous antifungal or steroid medications can reduce its effectiveness.

Background

Chronic pulmonary aspergillosis (CPA) is a slowly progressive fungal infection characterized by cavitating pulmonary consolidation and fibrosis. Elevated serum Aspergillus-specific immunoglobulin G (IgG) is a key diagnostic criterion for CPA. This study evaluates diagnostic testing methods for CPA in resource-limited settings.

Objective

To compare the diagnostic performance of Aspergillus-specific IgG immunochromatographic point-of-care test (ICT-POCT) versus enzyme-linked immunosorbent assay (ELISA) for CPA diagnosis across disease subtypes. The study aimed to identify factors influencing test accuracy and determine the clinical utility of rapid testing in resource-constrained settings.

Results

ICT assay demonstrated superior overall diagnostic performance (sensitivity: 88.4%; specificity: 95.1%) compared to ELISA (58.9% sensitivity, 82.0% specificity at 80 AU/mL). For CCPA, ICT sensitivity was 89.1%; for simple aspergilloma, 88.9%. Prior antifungal and steroid therapy significantly reduced the performance of both assays. Combined testing achieved peak specificity (98.4%) but reduced sensitivity versus individual tests.

Conclusion

Aspergillus-specific IgG ICT assay shows significant diagnostic value for CPA, particularly in untreated patients and the CCPA subtype. Its high specificity and rapid format position it as a valuable point-of-care tool for prompt CPA diagnosis in resource-limited settings, though prior antifungal/steroid therapy limits accuracy.
  • Published in:Journal of Thoracic Disease,
  • Study Type:Comparative Diagnostic Study,
  • Source: 10.21037/jtd-2025-110, PMID: 41229831
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