title: Bronchoalveolar galactomannan in invasive pulmonary aspergillosis: a prospective study in pediatric patients.
abstract: BACKGROUND
  Elevations in the number of immunocompromised patients in the past decade has lead to progressive increase in the incidence of Invasive Pulmonary Aspergillosis (IPA) among children; however, early diagnosis remains a challenge. Detection of galactomannan (GM) in the bronchoalveolar lavage (BAL) fluid appears to possess higher sensitivity and specificity than serum in immunocompromised adult patients but, it rarely has been investigated in pediatric patients.
  
  
  METHODS
  We performed a prospective case-control study to evaluate the efficacy of BAL GM in immunocompromised pediatric patients. Cases were subjects fulfilling the host factor criteria as defined by the EORTC/MSG and met established definitions for proven or probable IPA. Control group was patients with possible IPA in whom diagnoses other than IPA were confirmed and patients without risk factors of IPA who underwent bronchoscopy for other diagnostic purpose. Galactomannan testing was performed on BAL fluid samples using platelia Aspergillus seroassay.
  
  
  RESULTS
  Sixteen cases of IPA (4 proven, 12 probable) and 54 controls (6 possible IPA and 48 no IPA) were documented according to EORTC/MSG definitions. The sensitivity and positive predictive values of BAL GM using an OD index of ≥0.5 were 87.5% and 93.33% respectively. We found seven cases of IPA with negative serum GM while their BAL GM was positive.
  
  
  CONCLUSIONS
  We found high diagnostic value of BAL GM in immunocompromised pediatric patients with IPA. The lower OD index is necessary in children to avoid missing the cases of IPA in children.
authors.affiliation: Pediatric Respiratory Disease Research Center, National Research Institute of Tuberculosis and Lung Disease, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Shilan
authors.initials: S
authors.lastname: Mohammadi
authors.affiliation: Professor of Pediatrics pulmonologist, Pediatric Respiratory Disease Research Center, National Research Institute of Tuberculosis and Lung Disease, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Soheila
authors.initials: S
authors.lastname: Khalilzadeh
authors.affiliation: Assistant Professor of Pediatrics Hematology, Pediatric Congenital Hematologic Disorders Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Koroush
authors.initials: K
authors.lastname: Goudarzipour
authors.affiliation: Assistant Professor of Pediatrics pulmonologist, Pediatric Respiratory Disease Research Center, National Research Institute of Tuberculosis and Lung Disease, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Maryam
authors.initials: M
authors.lastname: Hassanzad
authors.affiliation: Associate Professor of Clinical Immunology, Pediatric Respiratory Disease Research Center, National Research Institute of Tuberculosis and Lung Disease, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Alireza
authors.initials: A
authors.lastname: Mahdaviani
authors.affiliation: Pediatric Congenital Hematologic Disorders Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Nahid
authors.initials: N
authors.lastname: Aarabi
authors.affiliation: Assistant Professor of Pathology, National Research Institute of Tuberculosis and Lung Disease, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Mihan
authors.initials: M
authors.lastname: Pourabdollah
authors.affiliation: Associate Professor of Pulmonology, Internal Medicine Department, Medical Faculty, Kurdistan University of Medical Sciences, Sanandaj, Iran naseh.sigari@muk.ac.ir.
authors.forename: Naseh
authors.initials: N
authors.lastname: Sigari
mesh_terms: D000293:Adolescent; D001992:Bronchoalveolar Lavage Fluid / Q000737:chemistry*; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005260:Female; D005690:Galactose / Q000031:analogs & derivatives; D006801:Humans; D016867:Immunocompromised Host; D007223:Infant; D055744:Invasive Pulmonary Aspergillosis / Q000175:diagnosis* / Q000473:pathology*; D008297:Male; D008351:Mannans / Q000032:analysis*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity
chemical_list: D008351:Mannans; C012990:galactomannan; D005690:Galactose
keywords: Aspergillosis; Bronchoalveolar lavage; Galactomannan; Immunocompromised pediatric patients