Abstract
BackgroundDiagnosis of fungal allergies in asthma remains problematic in low-and middle-income countries due to non-availability of point-of-care testing. In this study, we aimed to evaluate the performance of an Aspergillus immunochromatographic technology (ICT) IgG/M lateral flow device (LFD) for the serological diagnosis of allergic bronchopulmonary aspergillosis (ABPA) and severe asthma with fungal sensitisation (SAFS) among Ugandan adult asthmatics.Methods374 adult (aged ≥18years) asthmatics in the African Severe Asthma Program study, Ugandan site constituted the study population. ABPA and SAFS were diagnosed according to standard criteria. Asthmatics who did not meet the above criteria constituted a control group. The LFD tests were performed and read according to manufacturer’s instructions.ResultsABPA was found in 12/374 (3.2%) and SAFS in 60/374 (16%) participants. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for the Aspergillus ICT for the diagnosis of ABPA were 0.0%, 96.4%, 0.0% and 96.7% respectively, and for SAFS 6.7%, 97.1%, 30.8% and 84.5% respectively. False positive and negative rates were 3.5% and 3.2% for ABPA and 2.4% and 14.9% for SAFS, respectively. Patients with a positive LFD significantly had higher median Aspergillus fumigatus-specific IgE levels compared to those with negative LFD (median: 0.06 kUA/l VS 0.03 kUA/L, P = 0.011).ConclusionThe Aspergillus ICT IgG/M LFD had a poor diagnostic performance for the diagnosis of both ABPA and SAFS. Its greatest value may be in distinguishing chronic and allergic aspergillosis in Africa.
Highlights
Airway exposures to fungal elements among patients with asthma elicits immune responses and bronchopulmonary inflammation, typically presenting as severe asthma with fungal sensitization (SAFS) or allergic bronchopulmonary aspergillosis (ABPA) [1]
This was a cross-sectional study evaluating the diagnostic performance of the LDBio Aspergillus immunochromatographic technology (ICT) IgG-IgM lateral flow assay for the serological diagnosis of ABPA and severe asthma with fungal sensitisation (SAFS) among Ugandan adult asthmatics
This study was nested within the African Severe Asthma Program (ASAP) clinical study (ClinicalTrials.gov Identifier: NCT03065920) [23,24,25] at the Makerere University Lung Institute
Summary
Airway exposures to fungal elements among patients with asthma elicits immune responses and bronchopulmonary inflammation, typically presenting as severe asthma with fungal sensitization (SAFS) or allergic bronchopulmonary aspergillosis (ABPA) [1]. Aspergillus fumigatus is the usual culprit in fungal sensitization complicating 15–50% of cases of bronchial asthma, and associated with poor disease control [2]. Our recent work has shown that approximately over 4 million adult asthmatics in Africa have fungal sensitization, with an estimated 437,000 presenting with ABPA and 577,000 SAFS [10]. We aimed to evaluate the performance of an Aspergillus immunochromatographic technology (ICT) IgG/M lateral flow device (LFD) for the serological diagnosis of allergic bronchopulmonary aspergillosis (ABPA) and severe asthma with fungal sensitisation (SAFS) among Ugandan adult asthmatics
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