{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T04:04:10Z","timestamp":1780459450506,"version":"3.54.1"},"reference-count":21,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pathogens"],"abstract":"<jats:p>Background: The clinical burden of pulmonary diseases associated with the genus Aspergillus is increasing, although diagnostic focus remains largely on A. fumigatus. This study evaluated the diagnostic value of testing for A. flavus and A. niger-specific IgG in patients with chronic respiratory conditions. Methods: A retrospective study was conducted on 274 subjects (156 with chronic respiratory diseases, Bronchiectasis, Hypersensitivity Pneumonitis [HP], and Interstitial Lung Disease [ILD] non-HP, and 67 healthy controls). Cut-off values were established at the 97.5th percentile of the control group: 30 mg\/L for A. fumigatus, 13 mg\/L for A. flavus, and 8 mg\/L for A. niger. Results: Among 109 patients who tested negative for A. fumigatus, 49.5% showed positivity to at least one other species, preventing a significant diagnostic gap in exposure detection. Notably, 40.4% of these patients exhibited simultaneous positivity for both A. flavus and A. niger. In the HP subgroup, 100% of patients who were A. fumigatus-positive also showed concurrent positivity to the two other species. Furthermore, the Bronchiectasis group showed the highest rate of isolated A. flavus at 11.8%. Conclusions: Testing solely for A. fumigatus IgG leads to substantial underestimation of Aspergillus exposure. Integrating A. flavus and A. niger into diagnostic panels is essential for a comprehensive immunological assessment of fungal interaction, particularly in HP and ILD, where identifying specific antigenic exposure is crucial for managing chronic inflammation and preventing disease progression.<\/jats:p>","DOI":"10.3390\/pathogens15060597","type":"journal-article","created":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T02:37:26Z","timestamp":1780454246000},"page":"597","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Beyond Aspergillus fumigatus: The Clinical Burden of Aspergillus flavus and Aspergillus niger in Chronic Pulmonary Diseases"],"prefix":"10.3390","volume":"15","author":[{"given":"Lisa","family":"Brizzolara","sequence":"first","affiliation":[{"name":"Clinical Chemistry Laboratory, Fondazione IRCCS San Gerardo Dei Tintori, Via Pergolesi 33, 20900 Monza, Italy"},{"name":"School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0978-9573","authenticated-orcid":false,"given":"Jari","family":"Intra","sequence":"additional","affiliation":[{"name":"Clinical Chemistry Laboratory, Fondazione IRCCS San Gerardo Dei Tintori, Via Pergolesi 33, 20900 Monza, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paola","family":"Faverio","sequence":"additional","affiliation":[{"name":"Respiratory Diseases Unit, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alice","family":"Biffi","sequence":"additional","affiliation":[{"name":"Respiratory Diseases Unit, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Basta","sequence":"additional","affiliation":[{"name":"Clinical Chemistry Laboratory, Fondazione IRCCS San Gerardo Dei Tintori, Via Pergolesi 33, 20900 Monza, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina","family":"Delfini","sequence":"additional","affiliation":[{"name":"Clinical Chemistry Laboratory, Fondazione IRCCS San Gerardo Dei Tintori, Via Pergolesi 33, 20900 Monza, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-0636-0423","authenticated-orcid":false,"given":"Nicoletta","family":"Novati","sequence":"additional","affiliation":[{"name":"Clinical Chemistry Laboratory, Fondazione IRCCS San Gerardo Dei Tintori, Via Pergolesi 33, 20900 Monza, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisa","family":"Zucchetti","sequence":"additional","affiliation":[{"name":"Clinical Chemistry Laboratory, Fondazione IRCCS San Gerardo Dei Tintori, Via Pergolesi 33, 20900 Monza, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5775-5947","authenticated-orcid":false,"given":"Fabrizio","family":"Luppi","sequence":"additional","affiliation":[{"name":"Respiratory Diseases Unit, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4852-1318","authenticated-orcid":false,"given":"Marialuisa","family":"Lavitrano","sequence":"additional","affiliation":[{"name":"School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4968-1455","authenticated-orcid":false,"given":"Marco","family":"Casati","sequence":"additional","affiliation":[{"name":"Clinical Chemistry Laboratory, Fondazione IRCCS San Gerardo Dei Tintori, Via Pergolesi 33, 20900 Monza, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,1]]},"reference":[{"key":"ref_1","unstructured":"GBD 2023 Causes of Death Collaborators (2025). Global burden of 292 causes of death in 204 countries and territories and 660 subnational locations, 1990\u20132023: A systematic analysis for the Global Burden of Disease Study 2023. Lancet, 406, 1811\u20131872."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"S261","DOI":"10.1080\/13693780802247702","article-title":"Differences in pathogenicity and clinical syndromes due to Aspergillus fumigatus and Aspergillus flavus","volume":"47","author":"Pasqualotto","year":"2009","journal-title":"Med. Mycol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"14799731251326592","DOI":"10.1177\/14799731251326592","article-title":"Aspergillus IgG antibody testing in the diagnosis of hypersensitivity pneumonitis: A scoping review","volume":"22","author":"Hatim","year":"2025","journal-title":"Chron. Respir. Dis."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Bongomin, F., Asio, L.G., Baluku, J.B., Kwizera, R., and Denning, D.W. (2020). Chronic Pulmonary Aspergillosis: Notes for a Clinician in a Resource-Limited Setting Where There Is No Mycologist. J. Fungi, 6.","DOI":"10.3390\/jof6020075"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"8467","DOI":"10.21037\/jtd-2025-110","article-title":"Diagnostic performance of Aspergillus-specific immunoglobulin G immunochromatographic and enzyme-linked immunosorbent assay testing in chronic pulmonary aspergillosis: Comparative analysis across subtypes and influencing factors","volume":"17","author":"Duan","year":"2025","journal-title":"J. Thorac. Dis."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1016\/j.jmii.2025.10.003","article-title":"Aspergillus-specific immunoglobulin G seropositivity and lung function decline in patients with chronic lung diseases: A prospective cohort study","volume":"59","author":"Hu","year":"2025","journal-title":"J. Microbiol. Immunol. Infect."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"834","DOI":"10.1099\/jmm.0.018309-0","article-title":"Aspergillus niger: An unusual cause of invasive pulmonary aspergillosis","volume":"59","author":"Person","year":"2010","journal-title":"J. Med. Microbiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e36","DOI":"10.1164\/rccm.202005-2032ST","article-title":"Diagnosis of Hypersensitivity Pneumonitis in Adults. An Official ATS\/JRS\/ALAT Clinical Practice Guideline","volume":"202","author":"Raghu","year":"2020","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_9","first-page":"381","article-title":"The Role of Serum IgG Precipitins against Six Typical Organic Antigens Involved in Hypersensitivity Pneumonitis: A 10-Year Retrospective Study of a Referral Interstitial Lung Disease Centre","volume":"4","author":"Intra","year":"2024","journal-title":"Int. J. Transl. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"574","DOI":"10.1080\/20477724.2024.2424489","article-title":"Clinical applications of immunoglobulin G against different individual Aspergillus species for the diagnosis of chronic pulmonary aspergillosis among at-risk populations","volume":"118","author":"Keng","year":"2024","journal-title":"Pathog. Glob. Health"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Jabeen, K., Farooqi, J., Iqbal, N., Wahab, K., and Irfan, M. (2020). Aspergillus fumigatus and Aspergillus flavus-Specific IgG Cut-Offs for the Diagnosis of Chronic Pulmonary Aspergillosis in Pakistan. J. Fungi, 6.","DOI":"10.3390\/jof6040249"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e0016326","DOI":"10.1128\/jcm.00163-26","article-title":"Non-fumigatus Aspergillus-associated pulmonary events: A diagnostic challenge","volume":"64","author":"Godet","year":"2026","journal-title":"J. Clin. Microbiol."},{"key":"ref_13","first-page":"1297","article-title":"Characterization of antigens from Aspergillus fumigatus: III. Comparison of antigenic relationships of clinically important aspergilli","volume":"120","author":"Kim","year":"1979","journal-title":"Am. Rev. Respir. Dis."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1016\/j.jinf.2015.11.003","article-title":"Comparison of six Aspergillus-specific IgG assays for the diagnosis of chronic pulmonary aspergillosis (CPA)","volume":"72","author":"Page","year":"2016","journal-title":"J. Infect."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"S12","DOI":"10.1016\/j.alit.2018.04.009","article-title":"Concordance between Aspergillus-specific precipitating antibody and IgG in allergic bronchopulmonary aspergillosis","volume":"67","author":"Harada","year":"2018","journal-title":"Allergol. Int."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"866","DOI":"10.1111\/myc.13488","article-title":"Comparative diagnostic accuracy of immunoprecipitation versus immunoassay methods for detecting Aspergillus fumigatus-specific IgG in allergic bronchopulmonary aspergillosis: A systematic review and meta-analysis","volume":"65","author":"Sehgal","year":"2022","journal-title":"Mycoses"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2509","DOI":"10.1016\/j.jaip.2025.05.038","article-title":"Comparative diagnostic performance of mx4-IgE versus species-specific IgE for identifying allergic bronchopulmonary aspergillosis","volume":"13","author":"Agarwal","year":"2025","journal-title":"J. Allergy Clin. Immunol. Pract."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1605.e1","DOI":"10.1016\/j.cmi.2023.08.032","article-title":"Aspergillus-specific IgG antibodies for diagnosing chronic pulmonary aspergillosis compared to the reference standard","volume":"29","author":"Salzer","year":"2023","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"975","DOI":"10.1016\/j.chest.2024.06.3843","article-title":"Aspergillus Serologic Findings and Clinical Outcomes in Patients with Bronchiectasis: Data from the European Bronchiectasis Registry","volume":"167","author":"Pollock","year":"2025","journal-title":"Chest"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"360","DOI":"10.1159\/000548741","article-title":"Prospective Study of Aspergillus IgG and Clinical Outcomes in Patients with Bronchiectasis","volume":"105","author":"Yang","year":"2026","journal-title":"Respiration"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"11501","DOI":"10.21037\/jtd-2025-1548","article-title":"Allergic bronchopulmonary aspergillosis and Aspergillus-related airway diseases in bronchiectasis: A narrative review","volume":"17","author":"Agarwal","year":"2025","journal-title":"J. Thorac. Dis."}],"container-title":["Pathogens"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-0817\/15\/6\/597\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T03:27:06Z","timestamp":1780457226000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-0817\/15\/6\/597"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,1]]},"references-count":21,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["pathogens15060597"],"URL":"https:\/\/doi.org\/10.3390\/pathogens15060597","relation":{},"ISSN":["2076-0817"],"issn-type":[{"value":"2076-0817","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,1]]}}}