Bronchoalveolar lavage galactomannan in diagnosis of invasive pulmonary aspergillosis among solid-organ transplant recipients.
We review the experience at our institution with galactomannan (GM) testing of bronchoalveolar lavage (BAL) fluid in the diagnosis of invasive pulmonary aspergillosis (IPA) among solid-organ transplant recipients. Among 81 patients for whom BAL GM testing was ordered (heart, 24; kidney, 22; liver, 19; lung, 16), there were five cases of proven or probable IPA. All five patients had BAL GM of > or = 2.1 and survived following antifungal therapy. The sensitivity, specificity, and positive and negative predictive values for BAL GM testing at a cutoff of > or = 1.0 were 100%, 90.8%, 41.7%, and 100%, respectively. The sensitivity of BAL GM testing was better than that of conventional tests such as serum GM or BAL cytology and culture. Moreover, a positive BAL GM test diagnosed IPA several days to 4 weeks before other methods for three patients. Twelve patients had BAL GM of > or = 0.5 but no evidence of IPA. Among these, lung transplant recipients accounted for 41.7% (5/12) of the false-positive results, reflecting frequent colonization of airways in this population. Excluding lung transplants, the specificity and positive predictive value for other solid-organ transplants increased to 92.9% and 62.5%, respectively (cutoff, > or = 1.0). In conclusion, BAL GM testing facilitated more-rapid diagnoses of IPA and the institution of antifungal therapy among non-lung solid-organ transplant recipients and helped to rule out IPA.
Clancy
Cornelius J
CJ
Department of Medicine, University of Florida College of Medicine, Gainesville, FL 32610, USA. clancyn@medicine.ufl.edu
Jaber
Reia A
RA
Leather
Helen L
HL
Wingard
John R
JR
Staley
Benjamin
B
Wheat
L Joseph
LJ
Cline
Christina L
CL
Rand
Kenneth H
KH
Schain
Denise
D
Baz
Maher
M
Nguyen
M Hong
MH
D000293:Adolescent; D000328:Adult; D000368:Aged; D001228:Aspergillosis / Q000175:diagnosis* / Q000382:microbiology; D001992:Bronchoalveolar Lavage Fluid / Q000737:chemistry*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005690:Galactose / Q000031:analogs & derivatives; D006801:Humans; D008172:Lung Diseases, Fungal / Q000175:diagnosis* / Q000382:microbiology; D008297:Male; D008351:Mannans / Q000032:analysis*; D008875:Middle Aged; D016377:Organ Transplantation / Q000009:adverse effects*; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity
D008351:Mannans; C012990:galactomannan; D005690:Galactose