Aspergillus galactomannan antigen assay in bronchoalveolar lavage fluid for diagnosis of invasive pulmonary aspergillosis

Park, Seong Yeon; Lee, Sang‐Oh; Choi, Sang‐Ho; Sung, Heungsup; Kim, Mina; Choi, Chang‐Min; Hong, Sang-Bum; Oh, Yeon‐Mok; Shim, Tae Sun; Koh, Younsuck; Kim, Yang Soo; Woo, Jun Hee; Kim, Sung-Han

doi:10.1016/j.jinf.2010.08.014

Cited by 64 publications

(37 citation statements)

References 26 publications

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“…Hence, a culture-independent method may increase the yield of BAL fluid samples. Recently, the clinical utility of GM EIA detection using BAL fluid samples has been explored in a variety of adult and pediatric populations; these studies, which use various OD cutoff indices for positivity, have reported high sensitivities in hematology patients (2,3,7,13,19,22,24,26,28,30), most solid-organ transplant recipients (4), critically ill patients (21), and nonimmunocompromised patients (23). However, significantly lower sensitivities have been reported in lung transplant recipients (4,15,18,27).…”

Section: Discussionmentioning

confidence: 99%

Detection of Galactomannan in Bronchoalveolar Lavage Fluid Samples of Patients at Risk for Invasive Pulmonary Aspergillosis: Analytical and Clinical Validity

et al. 2012

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Invasive pulmonary aspergillosis (IPA) is frequent and often fatal in immunosuppressed patients. Timely diagnosis of IPA improves survival but is difficult to make. We examined the analytical and clinical validity of galactomannan (GM) testing of bronchoalveolar lavage (BAL) fluid in diagnosing IPA in a mixed population by retrospectively reviewing records of 251 consecutive at-risk patients for whom BAL fluid GM testing was ordered. The performance of the enzyme immunoassay was evaluated by using a range of index cutoffs to define positivity. Three samples were associated with proven IPA, 56 were associated with probable IPA, 63 were associated with possible invasive fungal disease (IFD), and 129 were associated with no IFD. Using a BAL fluid GM index of >0.8 (optimal optical density [OD] index cutoff identified by a receiver operating characteristic curve), the sensitivity in diagnosing proven and probable IPA was 86.4%, and the specificity was 90.7%. At this cutoff, positive and negative predictive values were 81% and 93.6%, respectively. However, an OD index value of >3.0 corresponded to a 100% specificity, thus ruling the disease in, irrespective of the pretest probability. Conversely, an OD index cutoff of <0.5 corresponded to a high sensitivity, virtually always ruling the disease out. For all values in between, the posttest probability of IPA depends largely on the prevalence of disease in the at-risk population and the likelihood ratio of the OD index value. Detection of GM in BAL fluid samples of patients at risk of IPA has an excellent diagnostic accuracy provided results are interpreted in parallel with clinicoradiological findings and pretest probabilities.

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Section: Discussionmentioning

confidence: 99%

Detection of Galactomannan in Bronchoalveolar Lavage Fluid Samples of Patients at Risk for Invasive Pulmonary Aspergillosis: Analytical and Clinical Validity

et al. 2012

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“…Therefore, rapid tests (such as antigen detection) are promising options. 12,13 Galactomannan is a cell wall constituent of aspergillus, which elaborates during replication. The sensitivity and specificity of serum galactomannan in invasive aspergillosis are 61% to 71% and 89% to 93%.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Serum and Bronchoalveolar Lavage Galactomannan in Diagnosing Invasive Aspergillosis in Solid-Organ Transplant Recipients

Tabarsi

Soraghi²,

Marjani³

et al. 2012

Exp Clin Transplant

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Objectives: This study sought to compare the sensitivities of serum galactomannan and bronchoalveolar lavage galactomannan in diagnosing invasive aspergillosis in solid-organ transplant recipients (lung and heart). Materials and Methods: This study took place in the lung transplant center of the National Research Institute for Tuberculosis and Lung Disease. All patients with clinical and radiologic manifestations suggestive of pulmonary infection were included. Serum and bronchoalveolar lavage galactomannan were measured. Results: Seventeen patients were included (lung, 15; heart, 1; heart-lung, 1). Probable or definite invasive aspergillosis was diagnosed in 9 patients. With a cutoff ≥ 0.5, serum galactomannan sensitivity and specificity for diagnosing invasive aspergillosis were 77.18% and 100%. Negative predictive value and positive predictive value were 80% and 100%. The sensitivity and specificity of bronchoalveolar lavage galactomannan for diagnosing invasive aspergillosis with cutoff of ≥ 0.5 was 100%. Conclusions: Regarding the high levels of mortality and problems in diagnosing this disease, using bronchoalveolar lavage galactomannan could be a suitable option.

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“…It also highlights invaluable diagnostic tools, such as CT and both serum and bronchio-alveolar lavage fluid GM (30,31), as part of the contemporary management of this disease, both in terms of diagnosis and monitoring for progression or resolution of the disease (32). Finally, it also reminds us of the importance of postmortem studies, a disappearing trend, in determining the cause of death and quantifying the burden of disease that the patient experienced.…”

Section: Commentarymentioning

confidence: 93%

Progressive Dispersion of Azole Resistance in Aspergillus fumigatus: Fatal Invasive Aspergillosis in a Patient with Acute Myeloid Leukemia Infected with an A. fumigatus Strain with a cyp51A TR ₄₆ Y121F M172I T289A Allele

Rößler

Bader

Stölzel

et al. 2017

Antimicrob Agents Chemother

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This Journal section presents a real, challenging case involving a multidrugresistant organism. The case authors present the rationale for their therapeutic strategy and discuss the impact of mechanisms of resistance on clinical outcome. An expert clinician then provides a commentary on the case.ABSTRACT Patients with hematologic malignancies as well as allogeneic hematopoietic stem cell transplantation (HSCT) patients are at high risk for invasive aspergillosis. Here, we report a culture-and autopsy-proven fatal invasive aspergillosis in an allogeneic HSTC patient which he developed despite posaconazole prophylaxis. The agent was determined to be an azole-resistant Aspergillus fumigatus strain bearing the cyp51A mutation combination TR 46 Y121F M172I T289A. At increasing frequency, the azole resistance of A. fumigatus is being reported globally, limiting treatment options and complicating regimens.

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Aspergillus galactomannan antigen assay in bronchoalveolar lavage fluid for diagnosis of invasive pulmonary aspergillosis

Cited by 64 publications

References 26 publications

Detection of Galactomannan in Bronchoalveolar Lavage Fluid Samples of Patients at Risk for Invasive Pulmonary Aspergillosis: Analytical and Clinical Validity

Detection of Galactomannan in Bronchoalveolar Lavage Fluid Samples of Patients at Risk for Invasive Pulmonary Aspergillosis: Analytical and Clinical Validity

Comparison of Serum and Bronchoalveolar Lavage Galactomannan in Diagnosing Invasive Aspergillosis in Solid-Organ Transplant Recipients

Progressive Dispersion of Azole Resistance in Aspergillus fumigatus: Fatal Invasive Aspergillosis in a Patient with Acute Myeloid Leukemia Infected with an A. fumigatus Strain with a cyp51A TR ₄₆ Y121F M172I T289A Allele

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Aspergillus galactomannan antigen assay in bronchoalveolar lavage fluid for diagnosis of invasive pulmonary aspergillosis

Cited by 64 publications

References 26 publications

Detection of Galactomannan in Bronchoalveolar Lavage Fluid Samples of Patients at Risk for Invasive Pulmonary Aspergillosis: Analytical and Clinical Validity

Detection of Galactomannan in Bronchoalveolar Lavage Fluid Samples of Patients at Risk for Invasive Pulmonary Aspergillosis: Analytical and Clinical Validity

Comparison of Serum and Bronchoalveolar Lavage Galactomannan in Diagnosing Invasive Aspergillosis in Solid-Organ Transplant Recipients

Progressive Dispersion of Azole Resistance in Aspergillus fumigatus: Fatal Invasive Aspergillosis in a Patient with Acute Myeloid Leukemia Infected with an A. fumigatus Strain with a cyp51A TR 46 Y121F M172I T289A Allele

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Progressive Dispersion of Azole Resistance in Aspergillus fumigatus: Fatal Invasive Aspergillosis in a Patient with Acute Myeloid Leukemia Infected with an A. fumigatus Strain with a cyp51A TR ₄₆ Y121F M172I T289A Allele