Clinical utility of Aspergillus galactomannan and PCR in bronchoalveolar lavage fluid for the diagnosis of invasive pulmonary aspergillosis in patients with haematological malignancies.
Interpretation of Aspergillus galactomannan (GM) and PCR results in bronchoalveolar lavage (BAL) fluid for the diagnosis of invasive pulmonary aspergillosis (IPA) in patients with haematological malignancies requires clarification. A total of 116 patients underwent BAL for investigation of new lung infiltrates: 40% were neutropenic, 68% and 36% were receiving mould-active antifungal agents and β-lactam antibiotics. The diagnosis of proven IPA (n = 3), probable IPA (n = 15), and possible invasive fungal disease (IFD, n = 50) was made without inclusion of GM results. BAL GM (at cut-off of 0.8) had lower diagnostic sensitivity for IPA than PCR (61% versus 78%) but higher specificity (93% versus 79%). Both tests had excellent negative predictive values (85-90%), supporting their utility in excluding IPA. The use of BAL GM and PCR results increased the certainty of Aspergillus aetiology in 7 probable IPA cases where fungal hyphae were detected in respiratory samples by microscopy, and upgraded 24 patients from possible IFD to probable IPA. Use of BAL GM and PCR improves the diagnosis of IPA.
Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, 381 Royal Parade, Parkville, Victoria 3052, Australia.
Siow-Chin
SC
Heng
Centre for Infectious Diseases and Microbiology Laboratory Services, ICMPR - Pathology West, Westmead Hospital and the University of Sydney, Darcy Road, Westmead, New South Wales 2145, Australia.
Sharon C-A
SC
Chen
Department of Infectious Diseases, Alfred Health and Monash University, Commercial Road, Melbourne, Victoria 3004, Australia; Centre for Biomedical Research, Burnet Institute, 85 Commercial Road, Melbourne, Victoria 3004, Australia.
C Orla
CO
Morrissey
Department of Infectious Diseases, Peter MacCallum Cancer Centre, St Andrews Place, East Melbourne, Victoria 3002, Australia; Faculty of Medicine, University of Melbourne, Grattan Street, Parkville, Victoria 3010, Australia.
Karin
K
Thursky
Division of Cancer Medicine, Peter MacCallum Cancer Centre, St Andrews Place, East Melbourne, Victoria 3002, Australia.
Renee L
RL
Manser
Centre for Biomedical Research, Burnet Institute, 85 Commercial Road, Melbourne, Victoria 3004, Australia.
Harini D
HD
De Silva
Centre for Infectious Diseases and Microbiology Laboratory Services, ICMPR - Pathology West, Westmead Hospital and the University of Sydney, Darcy Road, Westmead, New South Wales 2145, Australia.
Catriona L
CL
Halliday
Faculty of Medicine, University of Melbourne, Grattan Street, Parkville, Victoria 3010, Australia; Department of Haematology, Peter MacCallum Cancer Centre, St Andrews Place, East Melbourne, Victoria 3002, Australia.
John F
JF
Seymour
Drug Delivery, Disposition and Dynamic, Monash Institute of Pharmaceutical Sciences, Monash University, 381 Royal Parade, Parkville, Victoria 3052, Australia.
Roger L
RL
Nation
Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, 381 Royal Parade, Parkville, Victoria 3052, Australia; Drug Delivery, Disposition and Dynamic, Monash Institute of Pharmaceutical Sciences, Monash University, 381 Royal Parade, Parkville, Victoria 3052, Australia.
David C M
DC
Kong
Department of Infectious Diseases, Peter MacCallum Cancer Centre, St Andrews Place, East Melbourne, Victoria 3002, Australia; Faculty of Medicine, University of Melbourne, Grattan Street, Parkville, Victoria 3010, Australia. Electronic address: monica.slavin@petermac.org.
Monica A
MA
Slavin
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000946:Antigens, Fungal / Q000032:analysis; D001230:Aspergillus / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification*; D001992:Bronchoalveolar Lavage Fluid / Q000737:chemistry* / Q000382:microbiology*; D004271:DNA, Fungal / Q000032:analysis* / Q000235:genetics; D005690:Galactose / Q000031:analogs & derivatives; D019337:Hematologic Neoplasms / Q000150:complications; D006801:Humans; D007118:Immunoassay / Q000379:methods; D055744:Invasive Pulmonary Aspergillosis / Q000175:diagnosis*; D008297:Male; D008351:Mannans / Q000032:analysis*; D008875:Middle Aged; D016133:Polymerase Chain Reaction / Q000379:methods*; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D055815:Young Adult
D000946:Antigens, Fungal; D004271:DNA, Fungal; D008351:Mannans; C012990:galactomannan; D005690:Galactose
Aspergillus PCR; Diagnosis; Galactomannan; Haematology