title: Influence of mould-active antifungal treatment on the performance of the Aspergillus-specific bronchoalveolar lavage fluid lateral-flow device test.
abstract: The effect of mould-active antifungal (AF) therapy/prophylaxis on the performance of the Aspergillus-specific lateral-flow device (LFD) test for diagnosing invasive pulmonary aspergillosis (IPA) was evaluated. This was a retrospective analysis of patients diagnosed with probable or proven IPA (according to revised EORTC/MSG criteria) at the Medical University of Graz (Austria) and the University Hospital of Mannheim (Germany) between February 2011 and December 2014. In total, 60 patients with 63 bronchoalveolar lavage fluid (BALF) samples were included in the analysis. Patient charts were reviewed regarding AF treatment at the time of bronchoscopy, and the influence of AFs on the performance of the LFD and BALF galactomannan (GM) ELISA results was calculated. Overall, 54 patients (57 BALF samples) had probable IPA and 6 patients (6 samples) had proven IPA. In 21/63 samples (33%) (from 19 patients), systemic mould-active AFs had been initiated before bronchoscopy. Of 63 BALF samples, 16 (25%) yielded a false-negative LFD result. The sensitivity of the LFD for probable/proven IPA was significantly lower in those receiving mould-active AFs compared with those without (52% vs. 86%; P=0.006). Similar results were found for BALF GM, with sensitivities decreasing under systemic AFs (71% vs. 95%, P=0.013 with the 0.5 ODI cut-off; 52% vs. 81%, P=0.036 with the 1.0 cut-off). These results suggest that the sensitivity of the BALF LFD and BALF GM assays may be reduced in the presence of mould-active AF treatment. Negative results in patients on AFs should therefore be interpreted with caution.
authors.affiliation: Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria; Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 20, 8036 Graz, Austria.
authors.forename: Susanne
authors.initials: S
authors.lastname: Eigl
authors.affiliation: Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria.
authors.forename: Juergen
authors.initials: J
authors.lastname: Prattes
authors.affiliation: Department of Haematology and Oncology, Mannheim University Hospital, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
authors.forename: Mark
authors.initials: M
authors.lastname: Reinwald
authors.affiliation: Biosciences, University of Exeter, Exeter, EX4 Devon, UK.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Thornton
authors.affiliation: Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria.
authors.forename: Frederike
authors.initials: F
authors.lastname: Reischies
authors.affiliation: Department of Haematology and Oncology, Mannheim University Hospital, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
authors.forename: Birgit
authors.initials: B
authors.lastname: Spiess
authors.affiliation: Division of Haematology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 2, 8036 Graz, Austria.
authors.forename: Peter
authors.initials: P
authors.lastname: Neumeister
authors.affiliation: Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria.
authors.forename: Ines
authors.initials: I
authors.lastname: Zollner-Schwetz
authors.affiliation: Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria.
authors.forename: Reinhard B
authors.initials: RB
authors.lastname: Raggam
authors.affiliation: Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 20, 8036 Graz, Austria.
authors.forename: Holger
authors.initials: H
authors.lastname: Flick
authors.affiliation: Department of Haematology and Oncology, Mannheim University Hospital, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
authors.forename: Dieter
authors.initials: D
authors.lastname: Buchheidt
authors.affiliation: Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria.
authors.forename: Robert
authors.initials: R
authors.lastname: Krause
authors.affiliation: Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria; Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 20, 8036 Graz, Austria; Division of Infectious Diseases, Department of Medicine, University of California-San Diego, 200 West Arbor Drive 8208, San Diego, 92103 CA, USA. Electronic address: martin.hoenigl@medunigraz.at.
authors.forename: Martin
authors.initials: M
authors.lastname: Hoenigl
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000008:administration & dosage*; D000956:Antigens, Viral / Q000032:analysis*; D001230:Aspergillus / Q000302:isolation & purification*; D001317:Austria; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology*; D002846:Chromatography, Affinity / Q000379:methods*; D005188:False Negative Reactions; D005260:Female; D005690:Galactose / Q000031:analogs & derivatives; D005858:Germany; D006801:Humans; D055744:Invasive Pulmonary Aspergillosis / Q000175:diagnosis* / Q000188:drug therapy; D008297:Male; D008351:Mannans / Q000032:analysis*; D008875:Middle Aged; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D055815:Young Adult
chemical_list: D000935:Antifungal Agents; D000956:Antigens, Viral; D008351:Mannans; C012990:galactomannan; D005690:Galactose
keywords: Antifungal prophylaxis; Aspergillosis; Culture; Diagnosis; Galactomannan; Point-of-care