title: Galactomannan testing and Aspergillus PCR in same-day bronchoalveolar lavage and blood samples for diagnosis of invasive aspergillosis.
abstract: In recent years galactomannan antigen testing (GM) and also Aspergillus PCR have become increasingly important for diagnosis of invasive aspergillosis (IA). Whether or not these tests need to be performed with bronchoalveolar lavage fluid (BALF; i.e., primary site of infection), or testing of blood samples is sufficient, remains, however, a matter of debate. We evaluated the diagnostic performance of GM ELISA, and Aspergillus PCR by using BALF samples and blood samples obtained at the same day from a total of 53 immunocompromised patients (16 with probable/proven IA and 37 with no evidence of IA according to the revised EORTC/MSG criteria; 38 patients with hematological malignancies were prospectively enrolled at the Medical University of Graz, Austria, 15 patients with mixed underlying diseases at the Mannheim University Hospital). Patients with possible IA were excluded from this analysis. A total of 34/53 (64%) of all patients and 12/16 (75%) of patients with probable/proven IA received mold-active antifungal prophylaxis/therapy at the time of the BALF procedure. Sensitivities of GM and Aspergillus PCR were 38% and 44% in BALF, and 31% and 0% in blood, respectively. Best sensitivity (75%) for detecting proven/probable IA was achieved when BALF Aspergillus PCR, BALF GM (>1.0 ODI), BALF-culture and serum-GM (>0.5 ODI) were combined (specificity 95%). In conclusion, sensitivities of the evaluated diagnostic tests-when interpreted on their own-were low in BALF and even lower in blood, sensitivities increased markedly when diagnostic tests were combined.
authors.affiliation: Division of Pulmonology, Medical University of Graz, Graz, Austria.
authors.forename: Susanne
authors.initials: S
authors.lastname: Eigl
authors.affiliation: Division of Pulmonology, Medical University of Graz, Graz, Austria.|Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, Graz, Austria.|Division of Infectious Diseases, Department of Medicine, University of California-San Diego, San Diego, USA.|Center for Biomarker Research in Medicine, Graz, Austria.
authors.forename: Martin
authors.initials: M
authors.lastname: Hoenigl
authors.affiliation: Mannheim University Hospital, Mannheim, Germany.
authors.forename: Birgit
authors.initials: B
authors.lastname: Spiess
authors.affiliation: Division of Pulmonology, Medical University of Graz, Graz, Austria.
authors.forename: Sven
authors.initials: S
authors.lastname: Heldt
authors.affiliation: Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, Graz, Austria.|Center for Biomarker Research in Medicine, Graz, Austria.
authors.forename: Juergen
authors.initials: J
authors.lastname: Prattes
authors.affiliation: Division of Hematology, Medical University of Graz, Graz, Austria.
authors.forename: Peter
authors.initials: P
authors.lastname: Neumeister
authors.affiliation: Division of Hematology, Medical University of Graz, Graz, Austria.
authors.forename: Albert
authors.initials: A
authors.lastname: Wolfler
authors.affiliation: Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria.
authors.forename: Jasmin
authors.initials: J
authors.lastname: Rabensteiner
authors.affiliation: Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria.
authors.forename: Florian
authors.initials: F
authors.lastname: Prueller
authors.affiliation: Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, Graz, Austria.|Center for Biomarker Research in Medicine, Graz, Austria.
authors.forename: Robert
authors.initials: R
authors.lastname: Krause
authors.affiliation: Mannheim University Hospital, Mannheim, Germany.
authors.forename: Mark
authors.initials: M
authors.lastname: Reinwald
authors.affiliation: Division of Pulmonology, Medical University of Graz, Graz, Austria.
authors.forename: Holger
authors.initials: H
authors.lastname: Flick
authors.affiliation: Mannheim University Hospital, Mannheim, Germany.
authors.forename: Dieter
authors.initials: D
authors.lastname: Buchheidt
authors.affiliation: Mannheim University Hospital, Mannheim, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Boch
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000946:Antigens, Fungal / Q000032:analysis / Q000097:blood; D001228:Aspergillosis / Q000097:blood / Q000175:diagnosis*; D001230:Aspergillus / Q000235:genetics* / Q000378:metabolism*; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology*; D004271:DNA, Fungal / Q000032:analysis / Q000097:blood; D005260:Female; D005690:Galactose / Q000031:analogs & derivatives; D006801:Humans; D016867:Immunocompromised Host; D000072742:Invasive Fungal Infections / Q000097:blood / Q000175:diagnosis; D008297:Male; D008351:Mannans / Q000032:analysis* / Q000097:blood*; D008828:Microbiological Techniques; D008875:Middle Aged; D025202:Molecular Diagnostic Techniques; D016133:Polymerase Chain Reaction; D012680:Sensitivity and Specificity
chemical_list: D000946:Antigens, Fungal; D004271:DNA, Fungal; D008351:Mannans; C012990:galactomannan; D005690:Galactose
keywords: BAL; antifungal; culture; fungal; haematological malignancy; serum; whole blood