Table 2.
Diagnostic microbiological tests for pulmonary aspergillosis: summary of recent guideline recommendations
| Sample | Test | EORTC/MSG definition 2020 [15] | Guideline | Additional comments/data from systematic reviews | ||||
|---|---|---|---|---|---|---|---|---|
| ECIL 8 2021 [16] | ESCMID 2019 [13] | AAG 2021 [17] | IDSA 2016 [18] | IPFN 2017 [12]^^ | ||||
| Bronchoalveolar lavage (BAL) | Microscopy & culture | Probable | * | * | A II | A II | – | Remains “gold-standard” for IPA diagnosis [17, 18] |
| Galactomannan | Probable (ODI > 1.0) | A II (t) | B II (t) | A II& | A I | – | Sensitivity 82% Specificity 88% [61] | |
| Aspergillus PCR** | Probable | A II (t)~ | N/A | B II | N/A | – | Pan-fungal PCR may be considered in high-risk patients [54] | |
| Lung Biopsy | Histopathology & Culture | Proven | * | * | A II | A I | – | Remains “gold-standard” for IPA diagnosis [17, 18] |
| Aspergillus or Panfungal PCR | (for species identification) | A II | N/A | A II# | N/A | – | Sensitivity > 90% Specificity 99% [17]#^ | |
| Serum (Serum/whole blood/plasma for PCR) | Galactomannan | Probable (ODI > 1.0) | A II& | B II | B II& | A I | C II+ | Sensitivity 89% Specificity 85% [61] |
| B-G-Glucan | N/A | D II | D III | C II^ | A II^ | D III | Sensitivity 29–82% Specificity 50–83% [61]@ | |
| Aspergillus PCR | Probable | B II (t) | N/A | N/A | N/A | D II | Sensitivity 76% Specificity 58% [61] | |
AAG, Australasian Antifungal Guidelines; ECIL, European Conference on Infectious in Leukaemia; ESCMID, European Society for Clinical Microbiology and Infectious Diseases; IPFN, International Paediatric Fever and Neutropenia; ODI, optical density index; PCR, polymerase chain reaction
*Considered standard testing—appropriate efforts to identify causative pathogen recommended
~Recommendation for “PCR and molecular methods” whenever specimens are obtained
#Where fungal hyphae are visible (lower sensitivity for samples where fungal hyphae not visible—C II recommendation)
+Marginal recommendation against use in setting of prolonged fever and neutropenia
^General recommendation/data; no paediatric specific recommendation(s)/data provided
&ODI threshold of 0.5 recommended for clinical practice @for proven/probable invasive fungal disease
**Two consecutive serum/whole blood/plasma samples positive OR BAL fluid 2 or more duplicate tests positive OR at least one plasma/serum/whole blood sample positive and one BAL fluid positive
^^This guideline is not specific for pulmonary aspergillus, but rather for children with suspected fungal infection in the setting of prolonged febrile neutropenia
Strength of recommendation: A, strong (dark green); B, moderate (light green); C, marginal (yellow); D, recommendation against use (lilac); N/A, no consensus recommendation made based on review of available data
Level of evidence: I—at least one properly designed randomised controlled trial/high quality; II—at least one properly designed clinical trial without randomisation, cohort or case-controlled studies, or multiple time series/moderate quality; III—evidence from opinions of respected authorities/low quality; (t) transferred evidence (i.e. from different patient cohorts, or similar immune status situation)