EVIDENCE OF SHORTCOMINGS
National mycology laboratory diagnostic capacity for invasive fungal diseases in 2017:
Evidence of sub-optimal practice
In recent years there have been increasing reports of invasive fungal disease and the emergence of more intrinsically resistant species of pathogenic fungi, such as Candida auris. ESPAUR initiated an analysis of current practices in diagnosis and treatment of mycological infections. Key findings published the 2019 report 'National mycology laboratory diagnostic capacity for invasive fungal diseases in 2017;
A report commented under 'Highlights '
National mycology laboratory diagnostic capacity for invasive fungal diseases in 2017:
Evidence of sub-optimal practice
In recent years there have been increasing reports of invasive fungal disease and the emergence of more intrinsically resistant species of pathogenic fungi, such as Candida auris. ESPAUR initiated an analysis of current practices in diagnosis and treatment of mycological infections. Key findings published the 2019 report 'National mycology laboratory diagnostic capacity for invasive fungal diseases in 2017;
A report commented under 'Highlights '
- There is a need to improve the UK diagnostic capacity for invasive fungal diseases.
- A minority of laboratories have local access to 13-D-Glucan and galactomannan testing
- Susceptibility testing of Aspergillus is currently conducted by few laboratories
Fungal biomarker testing turn-around-times at the National Mycology Reference Laboratory: Setting the record straight. 2021
The MRL letter suggests that delays in reporting are caused at a number of points along the sample processing path such as delays in shipment, local laboratory handling time, all of which are out of control of the MRL. Direct access to MRL Laboratory reports has been available electronically for several years and help in accessing this facility is included in the letter as is the possibility of tracking sample progress.
The MRL letter suggests that delays in reporting are caused at a number of points along the sample processing path such as delays in shipment, local laboratory handling time, all of which are out of control of the MRL. Direct access to MRL Laboratory reports has been available electronically for several years and help in accessing this facility is included in the letter as is the possibility of tracking sample progress.
British Society for Medical Mycology best practice recommendations. 2015
- β-D-glucan screening of serum from patients at high risk of invasive fungal disease should be considered as a negative result has a high negative predictive value, enabling invasive fungal disease to be excluded.
- BAL fluid is recommended for diagnosis of invasive fungal disease in patients with haematological disease
- The recommendations emphasise .. and the need for susceptibility testing of all Aspergillus spp,
- All aspergillus isolates from patients who have allergic bronchopulmonary aspergillosis, aspergilloma, or acute or chronic aspergillosis should be susceptibility tested...itraconazole) in case additional susceptibility testing is needed at a later date.
An investigation of antifungal stewardship programmes in England 2017
- 'There is an urgent need to improve across many diagnostic areas including the timely accessibility of/to fungal biomarkers and susceptibility testing.'
- 'Clinicians say: lack of diagnostic tests or long TAT's of tests is a main issue when managing patients with suspected invasive fungal infections.'
NHS Antifungal Stewardship Implementation Pack - Version: 0.7 June 2019
This pack provides information and guidance to support the local implementation of this Improving Value initiative . A local implementation project can use the guidance contained within this pack to guide successful implementation.
This pack provides information and guidance to support the local implementation of this Improving Value initiative . A local implementation project can use the guidance contained within this pack to guide successful implementation.
Invasive Aspergillosis KEY PUBLICATIONS
COVID-19 associated invasive aspergillosis: data from the UK National Mycology Reference Laboratory. From the discussion 'In addition to radiological imaging, serial screening for CAPA (CoVID Associated Pulmonary Aspergillosis) in ICU patients with deteriorating respiratory function should include: (i) regular (at least weekly) Aspergillus antigen testing of serum samples, (ii) regular (at least weekly) BOG testing of serum samples , (iii) Aspergillus antigen testing of BAL fluids (where available) or non -directed lavages/tracheal aspirates and (iv) Aspergillus PCR in conjunction with conventional mycological examination (microscopy and culture) of respiratory secretions if available. '
COVID-19 associated invasive aspergillosis: data from the UK National Mycology Reference Laboratory. From the discussion 'In addition to radiological imaging, serial screening for CAPA (CoVID Associated Pulmonary Aspergillosis) in ICU patients with deteriorating respiratory function should include: (i) regular (at least weekly) Aspergillus antigen testing of serum samples, (ii) regular (at least weekly) BOG testing of serum samples , (iii) Aspergillus antigen testing of BAL fluids (where available) or non -directed lavages/tracheal aspirates and (iv) Aspergillus PCR in conjunction with conventional mycological examination (microscopy and culture) of respiratory secretions if available. '
Pulmonary Aspergillosis KEY PUBLICATIONS
Chronic Pulmonary Aspergillosis-Where Are We? and Where Are We Going?
'The use of Aspergillus lgG antibody as a diagnostic tool is far superior to the use of Aspergillus precipitins and should always be used as the gold standard ..to confirm infection.'
Chronic Pulmonary Aspergillosis-Where Are We? and Where Are We Going?
'The use of Aspergillus lgG antibody as a diagnostic tool is far superior to the use of Aspergillus precipitins and should always be used as the gold standard ..to confirm infection.'
Evaluation of LDBio Aspergillus ICT Lateral Flow Assay for lgG and lgM Antibody Detection in Chronic Pu monary Aspergillosis
The LDBIO Aspergillus ICT lgG-lgM immunochromatographic technology (ICT) test was compared with Aspergillus lgG titers in CPA patients, measured by lmmunoCAP-specific lgG assays (cutoff value, 40 mg of antigen-specific antibodies [mgA]/liter For proven CPA patients versus controls, sensitivity and specificity for the LDBio Aspergillus ICT were 91.6% and 98.0%, respectively. In contrast, the routinely used lmmunoCAP assay exhibited 80.5% sensitivity for the same cohort
Of the 154 patients in our CPA case group, 108 had precipitins testing (for Aspergillus antibody) performed as part of routine diagnostics, with 57.4% sensitivity.
The LDBIO Aspergillus ICT lgG-lgM immunochromatographic technology (ICT) test was compared with Aspergillus lgG titers in CPA patients, measured by lmmunoCAP-specific lgG assays (cutoff value, 40 mg of antigen-specific antibodies [mgA]/liter For proven CPA patients versus controls, sensitivity and specificity for the LDBio Aspergillus ICT were 91.6% and 98.0%, respectively. In contrast, the routinely used lmmunoCAP assay exhibited 80.5% sensitivity for the same cohort
Of the 154 patients in our CPA case group, 108 had precipitins testing (for Aspergillus antibody) performed as part of routine diagnostics, with 57.4% sensitivity.
Evaluation of the LDBio Aspergillus ICT lateral flow assay for serodiagnosis of allergic bronchopulmonary aspergillosis.
Early recognition and diagnosis of allergic bronchopulmonary aspergillosis (ABPA) is critical to improve patient symptoms, and antifungal therapy may prevent or delay progression of bronchiectasis and development of chronic pulmonary aspergillosis. ABPA and control sera collected at the National Aspergillosis Centre (Manchester, UK) and/or from the Manchester Allergy, Respiratory and Thoracic Surgery research biobank were evaluated using the Aspergillus ICT assay. Results were read both visually and digitally (using a lateral flow reader) . Serological Aspergillus-specific lgC and lgE, and total lgE titres were measured by lmmunoCAP.
. The test effectively distinguished between Aspergillus-sensitization complicating asthma and/or bronchiectasis , and underlying conditions. It is rapid (result in <30 minutes) and easy to perform, with simple result interpretation by visible insp ection. Overall, the LDBio Aspergillus ICT exhibits excellent performance as a screening tool in the ABPA diagnostic pathway
Early recognition and diagnosis of allergic bronchopulmonary aspergillosis (ABPA) is critical to improve patient symptoms, and antifungal therapy may prevent or delay progression of bronchiectasis and development of chronic pulmonary aspergillosis. ABPA and control sera collected at the National Aspergillosis Centre (Manchester, UK) and/or from the Manchester Allergy, Respiratory and Thoracic Surgery research biobank were evaluated using the Aspergillus ICT assay. Results were read both visually and digitally (using a lateral flow reader) . Serological Aspergillus-specific lgC and lgE, and total lgE titres were measured by lmmunoCAP.
. The test effectively distinguished between Aspergillus-sensitization complicating asthma and/or bronchiectasis , and underlying conditions. It is rapid (result in <30 minutes) and easy to perform, with simple result interpretation by visible insp ection. Overall, the LDBio Aspergillus ICT exhibits excellent performance as a screening tool in the ABPA diagnostic pathway
