Galactomannan in bronchoalveolar lavage fluid for diagnosis of invasive aspergillosis in non-hematological patients. Issue 6 (June 2016)

• Record Type: Journal Article
• Authors: Fortún, J.; Martín-Dávila, P.; Gomez Garcia de la Pedrosa, E.; Silva, J.T.; Garcia-Rodríguez, J.; Benito, D.; Venanzi, E.; Castaño, F.; Fernández-Ruiz, M.; Lazaro, F.; García-Luján, R.; Quiles, I.; Cabanillas, J.J.; Moreno, S.; Aguado, J.M.
• Is Part Of: Journal of infection. Volume 72:Issue 6(2016)
• Page Start: 738
• Page End: 744
• Publication Date: 2016-06
• Subjects: Galactomannan -- Bronchoalveolar lavage fluid -- Invasive aspergillosis; REIPI Red Española de Investigación en Patología Infecciosa -- SEIMC Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica; Infection -- Periodicals; Bacterial Infections -- Periodicals; Communicable Diseases -- Periodicals; Electronic journals; 616.905
• DOI: 10.1016/j.jinf.2016.02.019
• Languages: English
• ISSNs: 0163-4453

Abstract

Summary: Background: The role of galactomannan (GM) in serum or bronchoalveolar lavage fluid (BALF) for the diagnosis of invasive pulmonary aspergillosis (IPA) has been extensively evaluated in hematological patients, however its performance in non-hematological patients is not well established. Methods: We performed a multicenter retrospective study in 3 university hospitals in Madrid, Spain between 2010 and 2014. The study population comprised patients with chronic obstructive pulmonary disease (COPD) and patients with immunosuppressive conditions in whom IPA was suspected and for whom BALF GM was available. Patients with hematological disorders were excluded. Results: A total of 188 patients (35 with COPD and 153 with immunosuppressive conditions) were analyzed, and 31 cases of IPA (proven or probable) were identified. The global sensitivity of BALF GM (optical density index [ODI] ≥ 1.0) was 77.4%; sensitivity was higher in patients with immunosuppressive conditions than in patients with COPD (81.8% vs 66.7%; p: 0.38). In COPD patients, the best performance was obtained for BALF GM (ODI ≥ 0.5), although sensitivity (88.9%) was similar to that of BALF fungal culture (88.9%). The sensitivity of GM in serum was very poor in both populations (36.4% and 11.6%, respectively). Conclusions: In the present series, the diagnostic performance of BALF GM was good for IPA in non-hematological patients, especially in patients with immunosuppressive conditions. Highlights: During recent years, IPA has been increasingly reported in non-neutropenic patients, including solid organ transplant recipients, patients receiving long-term therapy with corticosteroids, and patients with COPD. BALF GM seems to be the method of choice for diagnosis of IPA in patients who develop airway-invasive forms. This multicenter, retrospective study suggests that BALF GM ODI ≥ 1.0 performed well in the diagnosis of IPA, especially in immunosuppressed patients.