title: The utility of bronchoalveolar lavage beta-D-glucan testing for the diagnosis of invasive fungal infections.
abstract: OBJECTIVE
  To investigate the utility of beta-D-glucan (BDG) testing in bronchoalveolar lavage (BAL) fluid for the diagnosis of invasive fungal infection (IFI), as compared to BAL galactomannan (GM).
  
  
  METHODS
  We retrospectively reviewed medical records of 132 consecutive patients at the National Institutes of Health (NIH) in whom BAL BDG testing was performed for diagnosis of pneumonia. Using the European Organization for Research and Treatment of Cancer/Mycoses Study Group guidelines, we determined which patients had proven or probable IFI, and assessed the diagnostic performance of BAL BDG testing, relative to BAL GM. We also determined the reproducibility of the BDG assay in BAL via repeat testing of patient samples.
  
  
  RESULTS
  Ten patients had Pneumocystis pneumonia, and 34 patients had proven/probable IFI, including 14 with invasive aspergillosis (IA). BAL BDG was 100% sensitive for Pneumocystis. Although BAL BDG had similar sensitivity to BAL GM for the diagnosis of IA and IFI, it exhibited inferior specificity. Repeat testing demonstrated poor reproducibility of the BDG assay in BAL but not in serum.
  
  
  CONCLUSIONS
  BDG testing exhibits poor specificity and reproducibility in BAL. Identification of the BAL-specific factors that may interfere with the performance of the assay could improve the clinical usefulness of BAL BDG testing.
authors.affiliation: Fungal Pathogenesis Unit, Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), 9000 Rockville Pike, Building 10 CRC, Room 11C 102, Bethesda, MD 20892, USA. Electronic address: Stacey.rose@nih.gov.
authors.forename: Stacey R
authors.initials: SR
authors.lastname: Rose
authors.affiliation: Fungal Pathogenesis Unit, Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), 9000 Rockville Pike, Building 10 CRC, Room 11C 102, Bethesda, MD 20892, USA.
authors.forename: Saraschandra
authors.initials: S
authors.lastname: Vallabhajosyula
authors.affiliation: Fungal Pathogenesis Unit, Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), 9000 Rockville Pike, Building 10 CRC, Room 11C 102, Bethesda, MD 20892, USA.
authors.forename: Miguel G
authors.initials: MG
authors.lastname: Velez
authors.affiliation: Office of Device Evaluation, Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD 20993, USA.
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Fedorko
authors.affiliation: Biostatistics Research Branch, NIAID, NIH, 6700A Rockledge Drive, Room 5135, Bethesda, MD 20817, USA.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: VanRaden
authors.affiliation: Experimental Transplantation and Immunology Branch, Center for Cancer Research, National Cancer Institute, 10 Center Drive, Building 10, Room 4B36, Bethesda, MD 20892, USA.
authors.forename: Juan C
authors.initials: JC
authors.lastname: Gea-Banacloche
authors.affiliation: Fungal Pathogenesis Unit, Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), 9000 Rockville Pike, Building 10 CRC, Room 11C 102, Bethesda, MD 20892, USA. Electronic address: lionakism@niaid.nih.gov.
authors.forename: Michail S
authors.initials: MS
authors.lastname: Lionakis
mesh_terms: D001992:Bronchoalveolar Lavage Fluid / Q000737:chemistry*; D005260:Female; D060585:Fusariosis / Q000097:blood / Q000175:diagnosis; D005690:Galactose / Q000031:analogs & derivatives; D006801:Humans; D055744:Invasive Pulmonary Aspergillosis / Q000097:blood / Q000175:diagnosis; D008172:Lung Diseases, Fungal / Q000097:blood / Q000175:diagnosis* / Q000382:microbiology; D008297:Male; D008351:Mannans / Q000032:analysis*; D009091:Mucormycosis / Q000097:blood / Q000175:diagnosis; D010143:Paecilomyces; D011020:Pneumonia, Pneumocystis / Q000097:blood / Q000175:diagnosis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D060645:Scopulariopsis; D012680:Sensitivity and Specificity; D047071:beta-Glucans / Q000032:analysis* / Q000097:blood
chemical_list: D008351:Mannans; D047071:beta-Glucans; C012990:galactomannan; D005690:Galactose
keywords: Aspergillosis; Beta-D-glucan; Bronchoalveolar lavage; Galactomannan; Invasive fungal infection