Comparison of diagnostic techniques in patients with COVID-19-associated pulmonary aspergillosis (CAPA) in a Venezuelan population
Main Article Content
Abstract
Background: Invasive aspergillosis related to COVID-19 or CAPA is defined by the association of a group of histological, mycological, radiological and clinical criteria that establish this disease as a secondary infection of high morbidity without timely diagnosis. Clinical and histological methods, due to the non-specific characterization of the disease, have been supported by techniques based on microbiological methods, such as culture and direct examination, with a sensitivity close to 50%, allowing the identification of biomarkers such as the GM of the pathogen, being the immunological techniques of greater sensitivity and specificity, the use of radial immunodiffusion and ELISA with antigens secreted by Aspergillus spp. are recommended. The objective of this article was to compare three different serological diagnostic methods used in the mycology laboratory to diagnose CAPA in a Venezuelan population.
Methods: Based on a longitudinal study, 77 patient samples diagnosed as positive for SARS-CoV-2 by RT-PCR were analyzed, of which 24 CAPA BAL samples were subsequently evaluated by conventional mycological diagnostic methods (direct examination and culture) and corresponding CAPA serum samples by three serological methods: DID, ELISA with Aspergillus pool antigen, and the Galactomannan detection with Lateral flow (GM- LFA) essay.
Results: By microscopy, fungal structures were observed in 18/24 patients and 16/24 were positive for GM-LFA. Regarding the DID assays, precipitating bands were obtained in 21/24 patients with 86% sensitivity; and 97% specificity. To use ELISA technique, shows that 16/24 sera from patients with aspergillosis were positive, which represents 66% sensitivity and 97% specificity. As for GM- LFA, all sera were tested and 16/24 positive sera were obtained with the commercial kit, representing 66% sensitivity and 97% specificity.
Conclusions: Finally, when comparing the three tests studied, all techniques were found to be highly sensitive and have excellent specificity, recommending that the diagnosis of CAPA and IPA be based on a combination of diagnostic assays.
Keywords:
Aspergillosis, COVID-19 Associated Pulmonary Aspergillosis, diagnostics, lateral flow assay, ELISA, serology
Article Details
How to Cite
ALVARADO, Primavera et al.
Comparison of diagnostic techniques in patients with COVID-19-associated pulmonary aspergillosis (CAPA) in a Venezuelan population.
Medical Research Archives, [S.l.], v. 12, n. 8, aug. 2024.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/5715>. Date accessed: 06 sep. 2024.
doi: https://doi.org/10.18103/mra.v12i8.5715.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
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35. Cazzaniga J, Koutras N, Patel P. Mortality and Clinical Outcomes of Aspergillus and COVID-19 Co-infection: A Retrospective Analysis. Cureus. 2023 Dec 11;15(12): e50321. doi: 10.7759/cureus.50321.
36. Múñez-Rubio E, Calderón-Parra J, Fernández-Cruz A, Moreno-Torres V, Blanco-Alonso S, Ramos-Martínez A. Re: 'the unique COVID-19 presentation of patients with B cell depletion' by Belkin et al. Clin Microbiol Infect. 2023 Feb;29(2):272-273. doi: 10.1016/j.cmi.2022.10.025.
37. G, Luna M, Lewis RE, Bodey GP, Chemaly R, Tarrand JJ, Safdar A, Raad II, Kontoyiannis DP. Invasive fungal infections in patients with hematologic malignancies in a tertiary care cancer center: an autopsy study over a 15-year period (1989-2003). Haematologica. 2006 Jul;91(7):986-9. Epub 2006.
38. M, Yazdani Charati J, Davoodi L, Arastehfar A, Moazeni M, Abastabar M, Haghani I, Mayahi S, Hoenigl M, Pan W, Hedayati MT. Comparative analysis of galactomannan lateral flow assay, galactomannan enzyme immunoassay and BAL culture for diagnosis of COVID-19-associated pulmonary aspergillosis. Mycoses. 2022 Oct;65(10):960-968. doi: 10.1111/myc.13518.
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2. Van Arkel ALE, Rijpstra TA, Belderbos HNA, van Wijngaarden P, Verweij PE, Bentvelsen RG. COVID-19-associated Pulmonary Aspergillosis. Am J Respir Crit Care Med. 2020 Jul 1;202(1):132-135. doi: 10.1164/rccm.202004-1038LE.
3. Latgé JP. Aspergillus fumigatus and aspergillosis. Clin Microbiol Rev. 1999 Apr;12(2):310-50. doi: 10.1128/CMR.12.2.310.
4. Houbraken J, Kocsubé S, Visagie CM, Yilmaz N, Wang XC, Meijer M, Kraak B, Hubka V, Bensch K, Samson RA, Frisvad JC. Classification of Aspergillus, Penicillium, Talaromyces and related genera (Eurotiales): An overview of families, genera, subgenera, sections, series and species. Stud Mycol. 2020 Jun 27; 95:5-169. doi: 10.1016/j.simyco.2020.05.002.
5. Kousha M, Tadi R, Soubani AO. Pulmonary aspergillosis: a clinical review. Eur Respir Rev. 2011 Sep 1;20(121):156-74. doi: 10.1183/09059180.00001011.
6. The Lancet. COVID-19 in Latin America-emergency and opportunity. Lancet. 2021 Jul 10;398(10295):93. doi: 10.1016/S0140-6736(21)01551-8.
7. Dueñas D, Daza J, Liscano Y. Coinfections and Superinfections Associated with COVID-19 in Colombia: A Narrative Review. Medicina (Kaunas). 2023 Jul 20;59(7):1336. doi: 10.3390/medicina59071336.
8. Hoenigl M, Seidel D, Sprute R, Cunha C, Oliverio M, Goldman GH, Ibrahim AS, Carvalho A. COVID-19-associated fungal infections. Nat Microbiol. 2022 Aug;7(8):1127-1140. doi: 10.1038/s41564-022-01172-2.
9. Chong WH, Neu KP. Incidence, diagnosis and outcomes of COVID-19-associated pulmonary aspergillosis (CAPA): a systematic review. J Hosp Infect. 2021 Jul; 113:115-129. doi: 10.1016/j.jhin.2021.04.012.
10. Martínez Méndez D, Hernández Valles R, Alvarado P, Mendoza M. Las micosis en Venezuela: casuística de los Grupos de Trabajo en Micología (1984-2010) Mycoses in Venezuela: Working Groups in Mycology reported cases (1984-2010). Rev Iberoam Micol. 2013 Jan 3;30(1):39-46. Spanish. doi: 10.1016/j.riam.2012.10.001.
11. Jain A, Taneja S. Post-COVID fungal infections of maxillofacial region: a systematic review. Oral Maxillofac Surg. 2022 Sep;26(3):357-363. doi: 10.1007/s10006-021-01010-5.
12. Yeoh DK, McMullan BJ, Clark JE, Slavin MA, Haeusler GM, Blyth CC. The Challenge of Diagnosing Invasive Pulmonary Aspergillosis in Children: A Review of Existing and Emerging Tools. Mycopathologia. 2023 Oct;188(5):731-743. doi: 10.1007/s11046-023-00714-4.
13. Heldt S, Hoenigl M. Lateral fow assays for the diagnosis of invasive aspergillosis: current status. Curr Fungal Infect Rep. 2017; 11:45–51.
14. Ghazanfari M, Yazdani Charati J, Davoodi L, Arastehfar A, Moazeni M, Abastabar M, Haghani I, Mayahi S, Hoenigl M, Pan W, Hedayati MT. Comparative analysis of galactomannan lateral flow assay, galactomannan enzyme immunoassay and BAL culture for diagnosis of COVID-19-associated pulmonary aspergillosis. Mycoses. 2022 Oct;65(10):960-968. doi: 10.1111/myc.13518.
15. Serin I, Baltali S, Cinli TA, Goze H, Demir B, Yokus O. Lateral flow assay (LFA) in the diagnosis of COVID-19-associated pulmonary aspergillosis (CAPA): a single-center experience. BMC Infect Dis. 2022 Nov 8;22(1):822. doi: 10.1186/s12879-022-07828-y.
16. Mercier T, Dunbar A, de Kort E, Schauwvlieghe A, Reynders M, Guldentops E, Blijlevens NMA, Vonk AG, Rijnders B, Verweij PE, Lagrou K, Maertens J. Lateral flow assays for diagnosing invasive pulmonary aspergillosis in adult hematology patients: A comparative multicenter study. Med Mycol. 2020 Jun 1;58(4):444-452. doi: 10.1093/mmy/myz079.
17. Stopiglia, C. D. O., Arechavala, A., Carissimi, M., Sorrentino, J. M., Aquino, V. R., Daboit, T. C., Scroferneker, M. L. Standardization and characterization of antigens for the diagnosis of aspergillosis. CJM. 2012. 58(4), 455–462. doi:10.1139/w2012-013.
18. Azevedo PZ, Sylvestre TF, Cavalcante Rde S, de Carvalho LR, Moris DV, de Oliveira ML, Mendes RP. Evaluation of the Double Agar Gel Immunodiffusion Test and of the Enzyme-Linked Immunosorbent Assay in the Diagnosis and Follow-Up of Patients with Chronic Pulmonary Aspergillosis. PLoS One. 2015 Aug 13;10(8):e0134841. doi: 10.1371/journal.pone.0134841.
19. Zambrano EA, Rodríguez I, Mendoza M, Santaella C, López M, Albornoz M. Regulation of serine-type exoproteinases by endogenous inhibitors present in exoantigens of the mycelial form of Paracoccidioides brasiliensis. Med Mycol. 2001 Aug;39(4):359-68. doi: 10.1080/mmy.39.4.359.368.
20. Alvarado P, Pérez-Rojas Y, Zambrano EA, Gonzatti M, González-AR. Improved serodiagnosis of histoplasmosis by use of deglycosylated extracellular released antigens of Histoplasma capsulatum. Microbiol Methods. 2020 Aug:175: 105981. doi: 10.1016/j.mimet.2020.105981.
21. Hornbeck P. Double-Immunodiffusion Assay for Detecting Specific Antibodies (Ouchterlony). Curr Protoc Immunol. 2017 Feb 2;116:2.3.1-2.3.4. doi: 10.1002/cpim.18.
22. Alvarado P, Ostos A, Franquiz N, Roschman-González A, Zambrano EA, Mendoza M. Diagnóstico serológico de la esporotricosis mediante el empleo del antígeno de micelio de Sporothrix schenckii sensu stricto. Invest Clin. 2015 Jun;56(2):111-22.
23. Guimarães AJ, Pizzini CV, de Matos Guedes HL, Albuquerque PC, Peralta JM, Hamilton AJ, Zancopé-Oliveira RM. ELISA for early diagnosis of histoplasmosis. J Med Microbiol. 2004 Jun;53(Pt 6):509-514. doi: 10.1099/jmm.0.05469-0. PMID: 15150330.
24. Almeida-Paes, R.; Almeida, M.d.A.; de Macedo, P.M.; Caceres, D.H.; Zancopé-Oliveira, R.M. Performance of Two Commercial Assays for the Detection of Serum Aspergillus Galactomannan in Non-Neutropenic Patients. J. Fungi 2022, 8, 741. https://doi.org/ 10.3390/jof8070741.
25. Bravo-Grau, S, Cruz, J.P. Diagnostic accuracy studies: tools for its interpretation. Rev. Chil. Radiol. 2015 21, 158–164.
26. Akhtar N, Khurshid Wani A, Kant Tripathi S, Prakash A, Amin-Ul Mannan M. The role of SARS-CoV-2 immunosuppression and the therapy used to manage COVID-19 disease in the emergence of opportunistic fungal infections: A review. Curr Res Biotechnol. 2022; 4:337-349. doi: 10.1016/j.crbiot.2022.08.001.
27. M, Hernández-Villena JV, Cascante J, Vincenti-González MF, Forero-Peña DA, Segovia MJ, Hampson K, Castro J, Grillet ME. Signatures of the Venezuelan Humanitarian Crisis in the First Wave of COVID-19: Fuel Shortages and Border Migration. Vaccines (Basel). 2021 Jul 1;9(7):719. doi: 10.3390/vaccines9070719.
28. Forero-Peña DA, Carrión-Nessi FS, Mendoza-Millán DL, Omaña-Ávila ÓD, Mejía-Bernard MD, Camejo-Ávila NA, Flora-Noda DM, Velásquez VL, Chacón-Labrador FR, Doval-Fernández JM, Maricuto AL, Grillet ME, Hernández-Villena JV, Vincenti-González MF, Paniz-Mondolfi AE, Orejas J, Rodríguez VI, Contreras MB, Guevara RN, Carballo M, Caldera J, Redondo MC, Landaeta ME. First wave of COVID-19 in Venezuela: Epidemiological, clinical, and paraclinical characteristics of first cases. J Med Virol. 2022 Mar;94(3):1175-1185. doi: 10.1002/jmv.27449.
29. Fortún, J., Meije, Y., Fresco, G., & Moreno, S. Aspergilosis. Formas clínicas y tratamiento. Enfermedades Infecciosas y Microbiología Clínica. 2012. 30(4), 201–208. doi: 10.1016/j.eimc.2011.12.005.
30. Shadrivova O, Gusev D, Vashukova M, Lobzin D, Gusarov V, Zamyatin M, Zavrazhnov A, Mitichkin M, Borzova Y, Kozlova O, Desyatik E, Burygina E, Ignatyeva S, Oganesyan E, Vasilyeva N, Klimko N, Working Group. COVID-19-Associated Pulmonary Aspergillosis in Russia. J Fungi (Basel). 2021 Dec 10;7(12):1059. doi: 10.3390/jof7121059.
31. Jenks JD, Nam HH, Hoenigl M. Invasive aspergillosis in critically ill patients: Review of definitions and diagnostic approaches. Mycoses. 2021 Sep;64(9):1002-1014. doi: 10.1111/myc.13274.
32. Dimopoulos G, Almyroudi MP, Myrianthefs P, Rello J: COVID-19-associated pulmonary aspergillosis (CAPA). J Intensive Med. 2021, 1:71-80. 10.1016/j.jointm.2021.07.001.
33. Bongomin F, Gago S, Oladele RO, Denning DW. Global and multi-national prevalence of fungal diseases-estimate precision. J Fungi. 20173(4):57. 10.3390/jof3040057.
34. Kousha M, Tadi R, Soubani AO: Pulmonary aspergillosis: a clinical review . Eur Respir Rev. 2011, 20:156-74. 10.1183/09059180.00001011.
35. Cazzaniga J, Koutras N, Patel P. Mortality and Clinical Outcomes of Aspergillus and COVID-19 Co-infection: A Retrospective Analysis. Cureus. 2023 Dec 11;15(12): e50321. doi: 10.7759/cureus.50321.
36. Múñez-Rubio E, Calderón-Parra J, Fernández-Cruz A, Moreno-Torres V, Blanco-Alonso S, Ramos-Martínez A. Re: 'the unique COVID-19 presentation of patients with B cell depletion' by Belkin et al. Clin Microbiol Infect. 2023 Feb;29(2):272-273. doi: 10.1016/j.cmi.2022.10.025.
37. G, Luna M, Lewis RE, Bodey GP, Chemaly R, Tarrand JJ, Safdar A, Raad II, Kontoyiannis DP. Invasive fungal infections in patients with hematologic malignancies in a tertiary care cancer center: an autopsy study over a 15-year period (1989-2003). Haematologica. 2006 Jul;91(7):986-9. Epub 2006.
38. M, Yazdani Charati J, Davoodi L, Arastehfar A, Moazeni M, Abastabar M, Haghani I, Mayahi S, Hoenigl M, Pan W, Hedayati MT. Comparative analysis of galactomannan lateral flow assay, galactomannan enzyme immunoassay and BAL culture for diagnosis of COVID-19-associated pulmonary aspergillosis. Mycoses. 2022 Oct;65(10):960-968. doi: 10.1111/myc.13518.
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