<i>Aspergillus fumigatus</i> and <i>Aspergillus flavus</i>-Specific IgG Cut-Offs for the Diagnosis of Chronic Pulmonary Aspergillosis in Pakistan
2020
Kauser Jabeen | Joveria Farooqi | Nousheen Iqbal | Khalid Wahab | Muhammad Irfan
Despite a high burden of chronic pulmonary aspergillosis (CPA) in Pakistan, <i>Aspergillus</i>-specific IgG testing is currently not available. Establishing cut-offs for <i>Aspergillus</i>-specific IgG for CPA diagnosis is crucial due to geographical variation. In settings such as Pakistan, where non-<i>Aspergillus fumigatus</i> (mainly <i>A. flavus</i>) <i>Aspergillus</i> species account for the majority of CPA cases, there is a need to explore additional benefit of <i>Aspergillus flavus</i>-specific IgG detection along with <i>A. fumigatus</i>-specific IgG detection. This study was conducted at the Aga Khan University, Karachi, Pakistan after ethical approval. Serum for IgG detection were collected after informed consent from healthy controls (<i>n</i> = 21), diseased controls (patients with lung diseases, <i>n</i> = 18), and CPA patients (<i>n</i> = 21). <i>A. fumigatus</i> and <i>A. flavus</i> IgG were detected using Siemens immulite assay. The sensitivity and specificity of <i>A. fumigatus</i>-specific IgG were 80.95% and 82.05%, respectively at a cut-off of 20 mg/L. The sensitivity and specificity of <i>A. flavus</i>-specific IgG were 80.95% and 79.49% at a cut-off of 30 mg/L. We report, for the first time, performance of <i>A. flavus</i>-specific IgG for CPA diagnosis. Although there was no statistically significant difference between the performance of both antigens, it seems contextually relevant to include <i>A. flavus</i> IgG in the CPA diagnostic algorithm in regions with higher non-<i>A. fumigatus</i> CPA infections.
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