Point-of-care testing for viral-associated pulmonary aspergillosis

Robina Aerts, Brice Autier, Maximilian Gornicec, Juergen Prattes, Katrien Lagrou, Jean-Pierre Gangneux, Martin Hoenigl

Over the last years, severe respiratory viral infections, particularly those caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the influenza virus, have emerged as risk factor for viral-associated pulmonary aspergillosis (VAPA) among critically ill patients. Delays in diagnosis of VAPA are associated with increased mortality. Point-of-care-tests may play an important role in earlier diagnosis of VAPA and thus improve patient outcomes. The following review will give an update on point-of-care tests for VAPA, analyzing performances in respiratory and blood specimens. Point-of-care tests have emerged, and particularly the IMMY Aspergillus galactomannan lateral flow assay (LFA) shows performances comparable to the galactomannan ELISA for diagnosis of VAPA. Notably, nearly all evaluations of POC tests for VAPA have been performed in COVID-19 patients, with very limited data in Influenza patients. For early diagnosis of COVID associated pulmonary aspergillosis (CAPA) the LFA has shown promising performances in respiratory samples, particularly in bronchoalveolar lavage fluid, and may thereby help in improving patient outcomes. In contrast, serum LFA testing may not be useful for early diagnosis of disease, except in cases with invasive tracheobronchial aspergillosis.