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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 (CPA) is a serious fungal lung infection that primarily affects people with existing lung conditions. This study compared two methods to detect the disease: a fast, portable test (ICT) and a traditional laboratory test (ELISA). The faster ICT test was more accurate overall and can provide results quickly in areas without advanced laboratory facilities. However, patients already taking antifungal medications had lower test accuracy with both methods.

Background

Elevated serum Aspergillus-specific immunoglobulin G (IgG) is a key diagnostic criterion for chronic pulmonary aspergillosis (CPA). Mycological culture exhibits low sensitivity and specialized serological assays are cost-prohibitive, making point-of-care tests critical in resource-limited settings where CPA burden is high.

Objective

This study evaluated the diagnostic performance of Aspergillus-specific IgG testing, comparing rapid immunochromatographic point-of-care test (ICT-POCT) with enzyme-linked immunosorbent assay (ELISA) for CPA and its subtypes, while identifying factors influencing test accuracy.

Results

ICT assay demonstrated superior overall diagnostic performance (sensitivity: 88.4%; specificity: 95.1%) versus ELISA (58.9% sensitivity, 82.0% specificity at 80 AU/mL cut-off). Combined testing achieved peak specificity (98.4%) but reduced sensitivity. Prior antifungal and steroid therapy significantly decreased the performance of both assays across all CPA subtypes.

Conclusion

The Aspergillus-specific IgG ICT assay shows significant diagnostic value for CPA, particularly in untreated patients and 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 clinicians should be aware of its limitations in patients 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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