title: Diagnosis of invasive pulmonary aspergillosis in children with bronchoalveolar lavage galactomannan.
abstract: BACKGROUND
  Invasive pulmonary aspergillosis (IPA) is a life-threatening complication in immunocompromised patients. Early diagnosis and therapy improves outcome. Assessment of galactomannan (GM) in bronchoalveolar lavage (BAL) fluid is a proposed tool to diagnose IPA. Little is known about the diagnostic value of BAL GM in children.
  
  
  METHODS
  Retrospectively, 72 bronchoscopies were analyzed for GM in patients fulfilling the host factor criteria as defined by the EORTC/MSG. A cut-off index value GM of ≥0.5 was used. Clinical data, results of chest CT-scans and BAL cultures were collected.
  
  
  RESULTS
  Sensitivity, specificity, PPV, and NPV of BAL GM for a diagnosis of proven and probable IPA (n = 41) were 82.4%, 87.5%, 82.4%, and 87.5% respectively. A significant relation was found for BAL GM and abnormal chest CT (P = 0.01). No significant relationship was observed between BAL Aspergillus sp. culture and chest CT (n = 47). BAL GM and serum GM correlated significantly. In 9 out of 12 patients classified as possible IPA, antifungal therapy was continued or started, despite a negative BAL GM.
  
  
  CONCLUSIONS
  BAL GM test had good diagnostic value in children suspected of IPA. However, the decision to continue or start antifungal therapy was mainly determined by the clinical suspicion of IPA based on chest CT-outcome, serum GM index values and failure of antibiotic therapy.
authors.affiliation: Division of Respiratory Medicine, Department of Pediatrics, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: Mark
authors.initials: M
authors.lastname: de Mol
authors.forename: Johan C
authors.initials: JC
authors.lastname: de Jongste
authors.forename: Mireille
authors.initials: M
authors.lastname: van Westreenen
authors.forename: Peter J F M
authors.initials: PJ
authors.lastname: Merkus
authors.forename: Andrica H C
authors.initials: AH
authors.lastname: de Vries
authors.forename: Wim C J
authors.initials: WC
authors.lastname: Hop
authors.forename: Adilia
authors.initials: A
authors.lastname: Warris
authors.forename: Hettie M
authors.initials: HM
authors.lastname: Janssens
mesh_terms: D000293:Adolescent; D001230:Aspergillus / Q000302:isolation & purification*; D018893:Bronchoalveolar Lavage / Q000379:methods*; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology*; D001999:Bronchoscopy; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D042241:Early Diagnosis; D005260:Female; D005500:Follow-Up Studies; D005690:Galactose / Q000031:analogs & derivatives; D006801:Humans; D007223:Infant; D055744:Invasive Pulmonary Aspergillosis / Q000175:diagnosis* / Q000382:microbiology; D008297:Male; D008351:Mannans; D015203:Reproducibility of Results; D012189:Retrospective Studies
chemical_list: D008351:Mannans; C012990:galactomannan; D005690:Galactose