Accuracy of serological tests for diagnosis of chronic pulmonary aspergillosis: a systematic review and meta-analysis

Chronic pulmonary aspergillosis (CPA) is a disease that benefits from cavities as after-effects of tuberculosis, presenting a high mortality rate. Serological tests like double agar gel immunodiffusion test (DID) or the counterimmunoelectrophoresis (CIE) test have been routinely used for CPA diagnosis in the absence of positive cultures; however, they have been replaced by enzyme-linked immunoassay (ELISA), with a variety of methods. This systematic review aims to compare the accuracy of the ELISA test with the reference test (DID and/or CIE) in CPA diagnosis. It was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA). The study was registered in PROSPERO under the registration number CRD42016046057. We searched the electronic databases MEDLINE (PubMed), EMBASE (Elsevier), LILACS (VHL), Cochrane library, and ISI Web of Science. Gray literature was researched in Google Scholars and conference abstracts. We included articles with patients or serum samples from CPA patients who underwent two serological tests: ELISA (index test) and IDD and/or CIE (reference test), using the accuracy of the tests as a result. Original articles were considered without a restriction of date or language. The pooled sensitivity, specificity, and summary receiver operating characteristic curves were estimated. We included 13 studies in the review, but only four studies were included in the meta-analysis. The pooled sensitivities and specificities were 0.93 and 0.97 for the ELISA test. For the reference test (DID and/or CIE), these values were 0.64 and 0.99. Analyses of summary receiver operating characteristic curves yielded 0.99 for ELISA and 0.99 for the reference test (DID and/or CIE). Our meta-analysis suggests that the diagnostic accuracy of ELISA is greater than that of the reference tests (DID and/or CIE) in early detection of CPA.