, Volume 41, Issue 6, pp 1163–1169 | Cite as

Comparison of a novel Aspergillus lateral-flow device and the Platelia® galactomannan assay for the diagnosis of invasive aspergillosis following haematopoietic stem cell transplantation

  • J. Held
  • T. Schmidt
  • C. R. Thornton
  • E. Kotter
  • H. Bertz
Brief Report



The detection of galactomannan in serum is a cornerstone for the diagnosis of invasive fungal disease (IFD). Because a delay in treatment initiation is associated with a poor outcome, the results have to be available promptly. However, due to methodological and economic reasons, the test frequencies of the commonly used galactomannan assays vary between daily to weekly, meaning that results may be available too late to be clinically useful. The novel Aspergillus lateral-flow device (Aspergillus-LFD) is a rapid test that may overcome these limitations.


We compared the diagnostic performance of the Aspergillus-LFD and the Platelia® Aspergillus EIA (GM-EIA) in serum from 101 patients during and after allogeneic haematopoietic stem cell transplantation (HSCT). Clinical data and sera were collected prospectively and patients classified according to the European Organisation for Research and Treatment of Cancer (EORTC)/Mycoses Study Group (MSG) 2008 guidelines.


By the end of hospitalisation, one proven, nine probable and 20 possible cases of IFD were identified. Depending on the number of positive serum samples required for test positivity, the sensitivities, specificities and diagnostic odds ratios in patients with proven and probable IFD were as follows. One positive serum required: Aspergillus-LFD 40.0 %, 86.8 % and 3.03; GM-EIA 40.0 %, 89.0 % and 3.64. Two positive sera required: Aspergillus-LFD 20.0 %, 97.8 % and 11.13; GM-EIA 30.0 %, 98.9 % and 38.57. Although the GM-EIA was positive in a higher percentage of samples, this did not result in an earlier diagnosis.


If used as a screening test (one positive serum required for test positivity) or to rule out IFD, the Aspergillus-LFD has shown a comparable diagnostic performance to the GM-EIA. However, if the results have to be confirmed by a second positive serum, the GM-EIA exhibited superior sensitivity. In terms of practicability, the Aspergillus-LFD has demonstrated to be a quick (15 min) and easy-to-use test for single-patient detection of Aspergillus antigens.


Aspergillosis Haematopoietic stem cell transplantation Galactomannan Biomarker Lateral-flow device Invasive fungal diseases 



We would like to thank Elfriede Rappold, Daniela Lörch and Suse Dadek for reading the Aspergillus-LFD as well as searching our serum archive and Jürgen Brandel for the illustrations. This work was not specially funded. Most of the results were generated during routine diagnostic activities. The Aspergillus-LFDs were kindly provided by Dr. Christopher R. Thornton, University of Exeter, UK.

Conflict of interest

Christopher R. Thornton developed the Aspergillus-LFD and is involved in its commercialisation. All other authors declare no conflict of interest.


  1. 1.
    Kurosawa M, Yonezumi M, Hashino S, Tanaka J, Nishio M, Kaneda M, Ota S, Koda K, Suzuki N, Yoshida M, Hirayama Y, Takimoto R, Torimoto Y, Mori A, Takahashi T, Iizuka S, Ishida T, Kobayashi R, Oda T, Sakai H, Yamamoto S, Takahashi F, Fukuhara T. Epidemiology and treatment outcome of invasive fungal infections in patients with hematological malignancies. Int J Hematol. 2012;96:748–57.PubMedCrossRefGoogle Scholar
  2. 2.
    von Eiff M, Roos N, Schulten R, Hesse M, Zühlsdorf M, van de Loo J. Pulmonary aspergillosis: early diagnosis improves survival. Respiration. 1995;62:341–7.CrossRefGoogle Scholar
  3. 3.
    Pfeiffer CD, Fine JP, Safdar N. Diagnosis of invasive aspergillosis using a galactomannan assay: a meta-analysis. Clin Infect Dis. 2006;42:1417–27.PubMedCrossRefGoogle Scholar
  4. 4.
    Leeflang MM, Debets-Ossenkopp YJ, Visser CE, Scholten RJPM, Hooft L, Bijlmer HA, Reitsma JB, Bossuyt PM, Vandenbroucke-Grauls CM. Galactomannan detection for invasive aspergillosis in immunocompromised patients. Cochrane Database Syst Rev. 2008;4:CD007394. doi: 10.1002/14651858.CD007394.PubMedGoogle Scholar
  5. 5.
    Thornton CR. Development of an immunochromatographic lateral-flow device for rapid serodiagnosis of invasive aspergillosis. Clin Vaccine Immunol. 2008;15:1095–105.PubMedCrossRefGoogle Scholar
  6. 6.
    Wiederhold NP, Thornton CR, Najvar LK, Kirkpatrick WR, Bocanegra R, Patterson TF. Comparison of lateral flow technology and galactomannan and (1–>3)-β-d-glucan assays for detection of invasive pulmonary aspergillosis. Clin Vaccine Immunol. 2009;16:1844–6.PubMedCrossRefGoogle Scholar
  7. 7.
    Wiederhold NP, Najvar LK, Bocanegra R, Kirkpatrick WR, Patterson TF, Thornton CR. Interlaboratory and interstudy reproducibility of a novel lateral-flow device and influence of antifungal therapy on detection of invasive pulmonary aspergillosis. J Clin Microbiol. 2013;51:459–65.PubMedCrossRefGoogle Scholar
  8. 8.
    Hoenigl M, Koidl C, Duettmann W, Seeber K, Wagner J, Buzina W, Wölfler A, Raggam RB, Thornton CR, Krause R. Bronchoalveolar lavage lateral-flow device test for invasive pulmonary aspergillosis diagnosis in haematological malignancy and solid organ transplant patients. J Infect. 2012;65:588–91.PubMedCrossRefGoogle Scholar
  9. 9.
    De Pauw B, Walsh TJ, Donnelly JP, Stevens DA, Edwards JE, Calandra T, Pappas PG, Maertens J, Lortholary O, Kauffman CA, Denning DW, Patterson TF, Maschmeyer G, Bille J, Dismukes WE, Herbrecht R, Hope WW, Kibbler CC, Kullberg BJ, Marr KA, Muñoz P, Odds FC, Perfect JR, Restrepo A, Ruhnke M, Segal BH, Sobel JD, Sorrell TC, Viscoli C, Wingard JR, Zaoutis T, Bennett JE; European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group; National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group. Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group. Clin Infect Dis. 2008;46:1813–21.PubMedCrossRefGoogle Scholar
  10. 10.
    Marr KA, Laverdiere M, Gugel A, Leisenring W. Antifungal therapy decreases sensitivity of the Aspergillus galactomannan enzyme immunoassay. Clin Infect Dis. 2005;40:1762–9.PubMedCrossRefGoogle Scholar
  11. 11.
    Stevens DA, Melikian GL. Aspergillosis in the ‘nonimmunocompromised’ host. Immunol Invest. 2011;40:751–66.PubMedCrossRefGoogle Scholar
  12. 12.
    White PL, Parr C, Thornton C, Barnes RA. Evaluation of real-time PCR, galactomannan enzyme-linked immunosorbent assay (ELISA), and a novel lateral-flow device for diagnosis of invasive aspergillosis. J Clin Microbiol. 2013;51:1510–6.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • J. Held
    • 1
  • T. Schmidt
    • 2
  • C. R. Thornton
    • 3
  • E. Kotter
    • 4
  • H. Bertz
    • 5
  1. 1.Institute of Medical Microbiology and HygieneUniversity Medical Centre FreiburgFreiburgGermany
  2. 2.Department of AnaesthesiologyHeart Centre Freiburg UniversityBad KrozingenGermany
  3. 3.Biosciences, College of Life and Environmental SciencesUniversity of ExeterExeterUK
  4. 4.Department of Diagnostic RadiologyUniversity Medical Centre FreiburgFreiburgGermany
  5. 5.Department of Haematology/OncologyUniversity Medical Centre FreiburgFreiburgGermany

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