A positive BAL galactomannan in non-haemato-oncology patients risks harmful overtreatment. Issue 12 (20th November 2019)

• Record Type: Journal Article
• Authors: Martinelli, Anthony W.; Patil, Parth; Wong, Vanessa K.; Enoch, David A.; Sander, Clare R.
• Is Part Of: Journal of medical microbiology. Volume 68:Issue 12(2019)
• Page Start: 1766
• Page End: 1770
• Publication Date: 2019-11-20
• Subjects: galactomannan -- aspergillosis -- BAL -- transplant -- Aspergillus -- non-haemato-oncology; Medical microbiology -- Periodicals; 616.9041
• DOI: 10.1099/jmm.0.001109
• Languages: English
• ISSNs: 0022-2615

Abstract

Abstract : Introduction . Evidence for the clinical utility of bronchoalveolar lavage (BAL) galactomannan in the management of fungal disease outside of haemato-oncology patients is limited. Aim . To determine how the introduction of BAL galactomannan testing impacted on the diagnosis and management of invasive aspergillosis and other fungal diseases in non-haemato-oncology patients. Methodology . Retrospective review of all adult patients (age ≥16 years) without a diagnosis of haematological malignancy who had a positive BAL galactomannan from 1 November 2014 to 30 April 2018. Using electronic patient records we obtained demographic data, clinical details, laboratory investigations, relevant radiology and antimicrobial history for each case. Results . In total, 121 episodes with a galactomannan OD index of ≥0.500 were included in the study; 29 cases (24 %) were felt to reflect fungal disease. Antifungal therapy was commenced as a direct consequence of a positive BAL galactomannan result in 13 patients where the ultimate diagnosis was subsequently considered to be non-mycological: associated medication-related side-effects in this group included deranged liver function tests ( n =3), rash ( n =1) and fever ( n =1), related to amphotericin B ( n =1) and voriconazole ( n =4). Conclusion . We show that vigilance is required when interpreting galactomannan results in non-haematology patients to avoid potentially harmful overtreatment.