title: Bronchoalveolar lavage lateral-flow device test for invasive pulmonary aspergillosis in solid organ transplant patients: a semiprospective multicenter study.
abstract: BACKGROUND
  Invasive pulmonary aspergillosis (IPA) remains an important cause of morbidity and mortality among patients undergoing solid organ transplantation (SOT). Because of the crude mortality of 80% to 90% in the absence of adequate treatment, timely diagnosis and early intervention with antifungal drugs are key factors in the successful treatment of IPA. Diagnosis, however, remains difficult. Therefore, new diagnostic tests are urgently needed. The Lateral-Flow Device (LFD) test is a rapid (15 min) single-sample point-of-care test that is based on the detection of an Aspergillus extracellular glycoprotein antigen by monoclonal antibody JF5.
  
  
  METHODS
  This semiprospective multicenter study evaluated the LFD test for IPA diagnosis (established by galactomannan and culture results) by using bronchoalveolar lavage (BAL) samples from patients after SOT. Participating centers were the three Austrian Medical Universities of Innsbruck, Vienna, and Graz.
  
  
  RESULTS
  Forty-seven BAL samples from 47 SOT patients were included (26 patients had undergone lung transplantation, 13 liver, 6 kidney, and 2 heart transplantation; 11 probable or proven IPA, 11 possible IPA, 25 no IPA) at the three Austrian Medical Universities of Innsbruck, Vienna, and Graz. Sensitivity and specificity, positive and negative predictive values, as well as diagnostic odds ratio of BAL LFD tests for probable IPA were 91%, 83%, 63%, 97%, and 50% (95% confidence interval, 5.4%-467%), respectively.
  
  
  CONCLUSIONS
  To conclude, the LFD test of BAL specimens is performed easily and provides accurate and rapidly available results in patients after SOT. Therefore, this new point-of-care test may be a promising diagnostic approach for detecting IPA using BAL specimens from SOT patients.
authors.affiliation: 1 Division of Clinical Microbiology, Medical University of Vienna, Vienna, Austria. 2 Division of Hygiene and Medical Microbiology, Innsbruck Medical University, Innsbruck, Austria. 3 Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, Graz, Austria. 4 Universitätsklinik für Anästhesie und Intensivmedizin, Innsbruck Medical University, Innsbruck, Austria. 5 Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Graz, Austria. 6 Division of Transplant Surgery, Medical University of Graz, Graz, Austria. 7 Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria. 8 Biosciences, University of Exeter, Exeter, United Kingdom. 9 Division of Pulmonology, Medical University of Graz, Graz, Austria. 10 Address correspondence to: Martin Hoenigl, M.D., Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, Graz, Austria.
authors.forename: Birgit
authors.initials: B
authors.lastname: Willinger
authors.forename: Michaela
authors.initials: M
authors.lastname: Lackner
authors.forename: Cornelia
authors.initials: C
authors.lastname: Lass-Flörl
authors.forename: Jürgen
authors.initials: J
authors.lastname: Prattes
authors.forename: Verena
authors.initials: V
authors.lastname: Posch
authors.forename: Brigitte
authors.initials: B
authors.lastname: Selitsch
authors.forename: Stephan
authors.initials: S
authors.lastname: Eschertzhuber
authors.forename: Katharina
authors.initials: K
authors.lastname: Hönigl
authors.forename: Christoph
authors.initials: C
authors.lastname: Koidl
authors.forename: Michael
authors.initials: M
authors.lastname: Sereinigg
authors.forename: Reinhard B
authors.initials: RB
authors.lastname: Raggam
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Thornton
authors.forename: Robert
authors.initials: R
authors.lastname: Krause
authors.forename: Martin
authors.initials: M
authors.lastname: Hoenigl
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology*; D003429:Cross Reactions; D005260:Female; D006801:Humans; D055744:Invasive Pulmonary Aspergillosis / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation / Q000009:adverse effects*; D019095:Point-of-Care Systems; D011446:Prospective Studies