title: Comparison of an Aspergillus real-time polymerase chain reaction assay with galactomannan testing of bronchoalvelolar lavage fluid for the diagnosis of invasive pulmonary aspergillosis in lung transplant recipients.
abstract: BACKGROUND
  Early diagnosis and treatment of invasive pulmonary aspergillosis (IPA) improves outcome.
  
  
  METHODS
  We compared the performance of publicly available pan-Aspergillus, Aspergillus fumigatus-, and Aspergillus terreus-specific real-time polymerase chain reaction (PCR) assays with the Platelia galactomannan (GM) assay in 150 bronchoalveolar lavage (BAL) samples from lung transplant recipients (16 proven/probable IPA, 26 Aspergillus colonization, 11 non-Aspergillus mold colonization, and 97 negative controls).
  
  
  RESULTS
  The sensitivity and specificity of pan-Aspergillus PCR (optimal quantification cycle [Cq], ≤35.0 by receiver operating characteristic analysis) and GM (≥.5) for diagnosing IPA were 100% (95% confidence interval, 79%-100%) and 88% (79%-92%), and 93% (68%-100%) and 89% (82%-93%), respectively. The sensitivity and specificity of A. fumigatus-specific PCR were 85% (55%-89%) and 96% (91%-98%), respectively. A. terreus-specific PCR was positive for the 1 patient with IPA due to this species; specificity was 99% (148 of 149 samples). Aspergillus PCR identified 1 patient with IPA not diagnosed by GM. For BAL samples associated with Aspergillus colonization, the specificity of GM (92%) was higher than that of pan-Aspergillus PCR (50%; P = .003). Among negative control samples, the specificity of pan-Aspergillus PCR (97%) was higher than that of BAL GM (88%; P = .03). Positive results for both BAL PCR and GM testing improved the specificity to 97% with minimal detriment to sensitivity (93%).
  
  
  CONCLUSIONS
  A recently developed pan-Aspergillus PCR assay and GM testing of BAL fluid may facilitate the diagnosis of IPA after lung transplantation. A. fumigatus- and A. terreus-specific real-time PCR assays may be useful in rapidly identifying the most common cause of IPA and a species that is intrinsically resistant to amphotericin B, respectively.
authors.affiliation: Department of Medicine, University of Pittsburgh, Pennsylvania, 15261, USA.
authors.forename: Me-Linh
authors.initials: ML
authors.lastname: Luong
authors.forename: Cornelius J
authors.initials: CJ
authors.lastname: Clancy
authors.forename: Aniket
authors.initials: A
authors.lastname: Vadnerkar
authors.forename: Eun Jeong
authors.initials: EJ
authors.lastname: Kwak
authors.forename: Fernanda P
authors.initials: FP
authors.lastname: Silveira
authors.forename: Mark C
authors.initials: MC
authors.lastname: Wissel
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Grantham
authors.forename: Ryan K
authors.initials: RK
authors.lastname: Shields
authors.forename: Maria
authors.initials: M
authors.lastname: Crespo
authors.forename: Joseph
authors.initials: J
authors.lastname: Pilewski
authors.forename: Yoshiya
authors.initials: Y
authors.lastname: Toyoda
authors.forename: Steven B
authors.initials: SB
authors.lastname: Kleiboeker
authors.forename: Diana
authors.initials: D
authors.lastname: Pakstis
authors.forename: Sushruth K
authors.initials: SK
authors.lastname: Reddy
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Walsh
authors.forename: M Hong
authors.initials: MH
authors.lastname: Nguyen
mesh_terms: D000328:Adult; D000368:Aged; D001232:Aspergillus fumigatus / Q000737:chemistry / Q000235:genetics / Q000302:isolation & purification*; D001992:Bronchoalveolar Lavage Fluid / Q000737:chemistry / Q000382:microbiology*; D019411:Clinical Laboratory Techniques / Q000379:methods*; D004271:DNA, Fungal / Q000235:genetics; D005260:Female; D005690:Galactose / Q000031:analogs & derivatives; D006801:Humans; D007124:Immunoenzyme Techniques / Q000379:methods; D055744:Invasive Pulmonary Aspergillosis / Q000175:diagnosis*; D016040:Lung Transplantation; D008297:Male; D008351:Mannans / Q000032:analysis; D008875:Middle Aged; D009172:Mycology / Q000379:methods*; D016133:Polymerase Chain Reaction / Q000379:methods*; D012680:Sensitivity and Specificity; D014180:Transplantation
chemical_list: D004271:DNA, Fungal; D008351:Mannans; C012990:galactomannan; D005690:Galactose