title: Bronchoalveolar Lavage Fluid (1,3)β-D-Glucan for the Diagnosis of Invasive Fungal Infections in Solid Organ Transplantation: A Prospective Multicenter Study.
abstract: BACKGROUND
  Prompt diagnosis of invasive fungal infections (IFI) remains a challenge. (1,3)β-D-glucan detection in bronchoalveolar lavage (BAL) fluid by Fungitell assay aims to further improve upon the test's utility by directly applying it to specimens from the target organ.
  
  
  METHODS
  A prospective multicenter analysis of the Fungitell assay was performed on BAL and serum samples obtained from nonselected solid-organ transplantation patients suffering from probable, proven or no IFI according to the revised criteria of the European Organisation for Research and Treatment of Cancer / Mycosis Study Group.
  
  
  RESULTS
  Two hundred thirty-three BAL and 109 serum specimens from 135 patients with proven, probable, or no IFI were tested. Based on a 100 pg/mL: cutoff per test sensitivity, specificity, positive and negative predictive values were 79.2%, 38.5%, 27.6%, and 86.3% in BALs and 79.2%, 81.8%, 69.2%, and 83.1% in sera investigated.
  
  
  CONCLUSIONS
  The accuracy of the (1,3)β-D-glucan test is marginal so that its utility as a clinical test for early diagnosis of IFI is questionable in the lung transplant population. Although the high negative predictive value of the Fungitell assay in both, BALs and sera, may support exclusion of pulmonary IFI in solid-organ transplantation patients, the low positive predictive value limits its utility as a screening tool for early diagnosis of IFI.
authors.affiliation: 1 Division of Hygiene and Medical Microbiology, Department of Hygiene, Microbiology and Social Medicine, Innsbruck Medical University, Austria. 2 Division of Clinical Microbiology, Institute of Laboratory, Medical University of Vienna, Austria. 3 Section of Infectious Diseases and Tropical Medicine and Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Austria. 4 Department of Pneumology, LKH Natters, Austria. 5 Department of Anaesthesia and Critical Care, Innsbruck Medical University, Austria.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Mutschlechner
authors.forename: Brigitte
authors.initials: B
authors.lastname: Risslegger
authors.forename: Birgit
authors.initials: B
authors.lastname: Willinger
authors.forename: Martin
authors.initials: M
authors.lastname: Hoenigl
authors.forename: Brigitte
authors.initials: B
authors.lastname: Bucher
authors.forename: Stephan
authors.initials: S
authors.lastname: Eschertzhuber
authors.forename: Cornelia
authors.initials: C
authors.lastname: Lass-Flörl
mesh_terms: D000328:Adult; D001317:Austria; D015415:Biomarkers / Q000032:analysis; D001992:Bronchoalveolar Lavage Fluid / Q000737:chemistry*; D016022:Case-Control Studies; D018592:Cross-Over Studies; D005260:Female; D006801:Humans; D008172:Lung Diseases, Fungal / Q000175:diagnosis* / Q000378:metabolism / Q000382:microbiology; D016040:Lung Transplantation / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation / Q000009:adverse effects*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011509:Proteoglycans; D015203:Reproducibility of Results; D016896:Treatment Outcome; D047071:beta-Glucans / Q000032:analysis* / Q000097:blood
chemical_list: D015415:Biomarkers; D011509:Proteoglycans; D047071:beta-Glucans; C010770:polysaccharide-K