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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

This study compared two blood tests for diagnosing chronic pulmonary aspergillosis (CPA), a chronic fungal lung infection caused by Aspergillus. The rapid immunochromatographic test (ICT) performed better overall than the traditional ELISA laboratory test, making it more useful as a quick diagnostic tool, especially in areas without advanced laboratory facilities. However, both tests were less accurate in patients who had recently taken antifungal or steroid medications.

Background

Chronic pulmonary aspergillosis (CPA) is a slowly progressive fungal infection caused by Aspergillus species, particularly affecting individuals with chronic lung disease and prior tuberculosis. Elevated serum Aspergillus-specific immunoglobulin G (IgG) is a key diagnostic criterion for CPA. Point-of-care tests (POCTs) for CPA diagnosis are gaining significant interest, particularly in resource-limited settings.

Objective

To evaluate and compare the diagnostic performance of Aspergillus-specific IgG testing using rapid immunochromatographic point-of-care test (ICT-POCT) versus enzyme-linked immunosorbent assay (ELISA) for CPA diagnosis across different disease subtypes and identify factors influencing test accuracy.

Results

ICT-POCT demonstrated superior overall diagnostic performance with 88.4% sensitivity and 95.1% specificity compared to ELISA (58.9% sensitivity, 82.0% specificity at 80 AU/mL cutoff). Combined testing achieved peak specificity (98.4%) but reduced sensitivity versus individual tests. Prior antifungal and steroid therapy significantly decreased the sensitivity of both assays across all CPA subtypes, with ICT sensitivity varying from 50% to 97.3% depending on comorbidities.

Conclusion

The Aspergillus-specific IgG ICT assay demonstrates significant diagnostic value for CPA, particularly in untreated patients and the chronic cavitary pulmonary aspergillosis (CCPA) subtype. Its high specificity and rapid point-of-care format position it as a valuable diagnostic tool for resource-limited settings, though clinicians should be aware of its limitations in patients recently receiving antifungal or steroid therapy.
  • Published in:Journal of Thoracic Disease,
  • Study Type:Comparative Diagnostic Study,
  • Source: 10.21037/jtd-2025-110; PMID: 41229831
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