title: Galactomannan detection in computerized tomography-based broncho-alveolar lavage fluid and serum in haematological patients at risk for invasive pulmonary aspergillosis.
abstract: We determined the value of galactomannan (GM) detection in computerized tomography (CT)-based broncho-alveolar lavage (BAL) fluid and serum for the diagnosis of invasive pulmonary aspergillosis (IPA) in haemato-oncological patients with neutropenia. CT of the thorax and BAL were performed systematically at predefined clinical indications. GM was determined by sandwich enzyme-linked immunosorbent assay; the clinicians were unaware of the results. Of 160 patients, 17 patients (10.6%) presented with proven, probable or suspected IPA. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of GM detection in CT-based BAL fluid were all 100%. For GM detection in serially sampled serum, the sensitivity was 47%, the specificity 93%, the PPV 73% and the NPV 82%. A non-blinded follow-up study was performed to validate these results. In this study, 22 of 198 patients (11.1%) presented with IPA, and the sensitivity, specificity, PPV and NPV of GM detection in CT-based BAL fluid were 85%, 100%, 100% and 88% respectively. None of BAL fluids obtained after antifungal treatment of 3 d or more were positive. These results indicate that, when CT is used systematically and at an early stage, GM detection in CT-based BAL fluid has a high PPV for diagnosing IPA early in untreated patients.
authors.affiliation: Department of Medical Microbiology and Infectious Diseases, Erasmus Medical Centre Rotterdam, the Netherlands.
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Becker
authors.forename: Elly J
authors.initials: EJ
authors.lastname: Lugtenburg
authors.forename: Jan J
authors.initials: JJ
authors.lastname: Cornelissen
authors.forename: Cindy
authors.initials: C
authors.lastname: Van Der Schee
authors.forename: Henk C
authors.initials: HC
authors.lastname: Hoogsteden
authors.forename: Siem
authors.initials: S
authors.lastname: De Marie
mesh_terms: D000328:Adult; D001228:Aspergillosis / Q000175:diagnosis* / Q000000981:diagnostic imaging; D015415:Biomarkers / Q000032:analysis / Q000097:blood; D001992:Bronchoalveolar Lavage Fluid / Q000737:chemistry* / Q000382:microbiology; D005500:Follow-Up Studies; D005690:Galactose / Q000031:analogs & derivatives; D019337:Hematologic Neoplasms / Q000000981:diagnostic imaging / Q000382:microbiology*; D006801:Humans; D008172:Lung Diseases, Fungal / Q000175:diagnosis* / Q000000981:diagnostic imaging; D008351:Mannans / Q000032:analysis* / Q000097:blood; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012306:Risk; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed
chemical_list: D015415:Biomarkers; D008351:Mannans; C012990:galactomannan; D005690:Galactose