Diagnosis of invasive aspergillosis in hematological malignancy patients: Performance of cytokines, Asp LFD, and Aspergillus PCR in same day blood and bronchoalveolar lavage samples. Issue 3 (September 2018)

• Record Type: Journal Article
• Authors: Heldt, Sven; Prattes, Juergen; Eigl, Susanne; Spiess, Birgit; Flick, Holger; Rabensteiner, Jasmin; Johnson, Gemma; Prüller, Florian; Wölfler, Albert; Niedrist, Tobias; Boch, Tobias; Neumeister, Peter; Strohmaier, Heimo; Krause, Robert; Buchheidt, Dieter; Hoenigl, Martin
• Is Part Of: Journal of infection. Volume 77:Issue 3(2018)
• Page Start: 235
• Page End: 241
• Publication Date: 2018-09
• Subjects: Hematological malignancy -- Aspergillus -- Mold infection -- Serum -- BAL -- IL-8 -- Mold-active antifungals -- Galactomannan -- Prophylaxis; Infection -- Periodicals; Bacterial Infections -- Periodicals; Communicable Diseases -- Periodicals; Electronic journals; 616.905
• DOI: 10.1016/j.jinf.2018.05.001
• Languages: English
• ISSNs: 0163-4453

Abstract

Highlights: Blood and BALF biomarkers for diagnosis of invasive aspergillosis were evaluated. Biomarkers showed overall better performance in BALF compared to blood. In blood, IL-8 proved to be the most reliable biomarker showing high specificity. Combination of blood IL-8 with BAL Aspergillus -specific LFD showed high sensitivity. Combination of blood IL-8 with BAL Aspergillus PCR was also highly sensitive for IA. Summary: Background: Aspergillus spp. induce elevated levels of several cytokines. It remains unknown whether these cytokines hold value for clinical routine and enhance diagnostic performances of established and novel biomarkers/tests for invasive aspergillosis (IA). Methods: This cohort study included 106 prospectively enrolled (2014–2017) adult cases with underlying hematological malignancies and suspected pulmonary infection undergoing bronchoscopy. Serum samples were collected within 24 hours of bronchoalveolar lavage fluid (BALF) sampling. Both, serum and BALF samples were used to evaluate diagnostic performances of the Aspergillus -specific lateral-flow device test (LFD), Aspergillus PCR, β-D-glucan, and cytokines that have shown significant associations with IA before. Results: Among 106 cases, 11 had probable IA, and 32 possible IA; 80% received mold-active antifungals at the time of sampling. Diagnostic tests and biomarkers showed better performance in BALF versus blood, with the exception of serum interleukin (IL)-8 which was the most reliable blood biomarker. Combinations of serum IL-8 with either BALF LFD (sensitivity 100%, specificity 94%) or BALF PCR (sensitivity 91%, specificity 97%) showed promise for differentiating probable IA from no IA. Conclusions: High serum IL-8 levels were highly specific, and when combined with either the BALF Aspergillus -specific LFD, or BALF Aspergillus PCR also highly sensitive for diagnosis of IA. Graphical abstract: