Detection of Invasive Pulmonary Aspergillosis in Haematological Malignancy Patients by using Lateral-flow Technology

• DOI: 10.3791/3721
• Publication Date: 2012-03-23T11:49:26Z
• Authors: Christopher Thornton; Gemma Johnson; Samir Agrawal
• Keywords: Galactomannan; Gold standard (test)

Invasive pulmonary aspergillosis (IPA) is a leading cause of morbidity and mortality in haematological malignancy patients hematopoietic stem cell transplant recipients(1). Detection IPA represents formidable diagnostic challenge and, the absence 'gold standard', relies on combination clinical data microbiology histopathology where feasible. Diagnosis must conform to European Organization for Research Treatment Cancer National Institute Allergy Infectious Diseases Mycology Study Group (EORTC/MSG) consensus defining "proven", "probable", "possible" invasive fungal diseases(2). Currently, no nucleic acid-based tests have been externally validated detection so polymerase chain reaction (PCR) not included current EORTC/MSG criteria. Identification Aspergillus histological sections problematic because similarities hyphal morphologies with other pathogens(3), proven identification requires isolation etiologic agent pure culture. Culture-based approaches rely availability biopsy samples, but these are always accessible sick patients, do yield viable propagules culture when obtained. An important feature pathogenesis angio-invasion, trait that provides opportunities track fungus immunologically using detect characteristic antigenic signatures molecules serum bronchoalveolar lavage (BAL) fluids. This has led development Platelia enzyme immunoassay (GM-EIA) detects galactomannan 'pan-fungal' assay (Fungitell test) conserved wall component (1 →3)-β-D-glucan, mucorales lack this their walls(1,4). Issues surrounding accuracy tests(1,4-6) recent next-generation monoclonal antibody (MAb)-based assays surrogate markers infection(1,5). Thornton(5) recently described generation an Aspergillus-specific MAb (JF5) hybridoma technology its use develop immuno-chromatographic lateral-flow device (LFD) point-of-care (POC) diagnosis IPA. A major advantage LFD ability activity since JF5 binds extracellular glycoprotein antigen secreted during active growth only(5). consideration fluids such as lung BAL diagnosing spores common inhaled air. The utility demonstrated animal model infection, displayed improved sensitivity specificity compared GM Fungitell → 3)-β-D-glucan assays(7). Here, we present simple procedure human Its speed novel adjunct test patients.