Bronchoalveolar Lavage Lateral-Flow Device Test for Invasive Pulmonary Aspergillosis in Solid Organ Transplant Patients

Willinger, Birgit; Lackner, Michaela; Lass‐Flörl, Cornelia; Prattes, Juergen; Posch, Verena; Selitsch, Brigitte; Eschertzhuber, Stephan; Hönigl, Katharina; Koidl, Christoph; Sereinigg, Michael; Raggam, Reinhard B.; Thornton, Christopher R.; Krause, Robert; Hoenigl, Martin

doi:10.1097/tp.0000000000000153

Cited by 60 publications

(66 citation statements)

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“…In this study, the sensitivity of the LFD for IPA diagnosis in patients with underlying respiratory diseases was 77%, and the specificity was 92%, for proven/probable disease (vs. no IPA) and was therefore comparable to previous results in other patient populations, indicating the high diagnostic potential of this test when combined with BAL samples. Of interest is also the high NPV of the BAL LFD test, which was 97% in this study and also between 95 and 100% in previous studies (27,29,31). Azoulay and colleagues previously reported that up to two-thirds of patients receiving antifungal therapy in the ICU setting have no evidence for IFIs (46).…”

Section: Discussionmentioning

confidence: 81%

“…This is the first study to investigate the diagnostic performance of the BAL LFD test in patients with underlying respiratory diseases and without hematological malignancies or previous SOT. Previous studies evaluated the diagnostic performance of BAL LFD test in different patient populations: in SOT recipients sensitivity reached 91% and specificity 88% (29), and in patients with underlying hematological malignancies sensitivity reached 85% and specificity 100% when compared with patients Definition of abbreviations: BAL = bronchoalveolar lavage; BDG = 1,3-beta-D-glucan; CI = confidence interval; DOR = diagnostic odds ratio; GM = galactomannan; IPA = invasive pulmonary aspergillosis; LFD = lateral-flow device; NPV = negative predictive value; ODI = optical density index; PPV = positive predictive value. Data are presented as % (n/total) unless otherwise noted.…”

Section: Discussionmentioning

confidence: 99%

“…The LFD is easily performed using native BALF and yields results in 15 minutes. In recent studies, the high potential of this new assay in BAL IPA detection was shown in hematological malignancy and solid-organ transplant (SOT) patients (26)(27)(28)(29)(30)(31). However, no data on the performance of the LFD test in nonneutropenic patients with underlying respiratory diseases have been published to date.…”

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confidence: 99%

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Novel Tests for Diagnosis of Invasive Aspergillosis in Patients with Underlying Respiratory Diseases

Prattes

Flick²,

Prüller

et al. 2014

Am J Respir Crit Care Med

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Rationale: Invasive pulmonary aspergillosis has been increasingly reported in nonneutropenic patients, including those with underlying respiratory diseases.Objectives: We compared the diagnostic performances of galactomannan, 1,3-b-D-glucan, and Aspergillus-specific lateralflow device tests with that of conventional culture by using bronchoalveolar lavage fluid samples from patients with underlying respiratory diseases.Methods: We analyzed 268 bronchoalveolar lavage samples from 221 patients with underlying respiratory diseases (and without hematologic malignancy or previous solid organ transplantation) that were collected for routine microbiological workup between February 2012 and May 2014 at the University Hospital of Graz, Austria. Invasive pulmonary aspergillosis was defined according to European Organization of Research and Treatment of Cancer/ Mycoses Study Group criteria modified for patients with respiratory diseases.Measurements and Main Results: Thirty-one patients (14%) had probable or proven, 25 possible, and the remaining 165 patients no invasive pulmonary aspergillosis. Probable/proven aspergillosis was associated with a significantly higher (P = 0.034) 30-day mortality rate of 32%. Sensitivities, specificities, and diagnostic odd ratios differed markedly between galactomannan (cut-off 0. Conclusions: Probable or proven invasive pulmonary aspergillosis was diagnosed in 14% of our study population and associated with significantly higher 30-day mortality rates. Although the performance of b-D-glucan was limited by low specificity and that of mycological culture by low sensitivity, the Aspergillus lateral-flow device seems to be a promising alternative to galactomannan testing, which remains the diagnostic gold standard for aspergillosis. Clinical trial registered with www.clinicaltrials.gov (NCT 02058316).

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Section: Discussionmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Novel Tests for Diagnosis of Invasive Aspergillosis in Patients with Underlying Respiratory Diseases

Prattes

Flick²,

Prüller

et al. 2014

Am J Respir Crit Care Med

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119

114

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“…1. A total of seven studies were included in our analysis (Held et al, 2013;Hoenigl et al, 2012Hoenigl et al, , 2014Prattes et al, 2014;Thornton, 2008;White et al, 2013;Willinger et al, 2014). The characteristics of the studies are shown in Table 1.…”

Section: Overall Analysismentioning

confidence: 99%

Diagnostic accuracy of a novel lateral-flow device in invasive aspergillosis: a meta-analysis

Pan

Zhang

et al. 2015

Journal of Medical Microbiology

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A novel lateral-flow device (LFD) has been invented for use as a diagnostic tool for invasive aspergillosis (IA). We conducted a meta-analysis to assess the diagnostic accuracy of the device. Published studies that used the European Organization for Research and Treatment of Cancer/Mycoses Study Group criteria and provided sufficient data were included. Two reviewers independently collected the data from each study and assessed the risk bias using the Quality Assessment of Diagnostic Accuracy Studies-2. The pooled sensitivity, specificity and diagnostic odds ratio (DOR) were computed and reported with a 95 % confidence interval 90 (95 % CI,) in the LFD test using serum. We concluded that the Aspergillus LFD had a good diagnostic value in immunocompromised patients at risk of IA. The BAL LFD might have a better performance than the serum LFD test.

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“…[5][6][7] In recent years, antigen testing has become one of the cornerstones of invasive fungal infection (IFI) diagnostics. 8,9 Galactomannan (GM) is a polysaccharide component of the cell wall of Aspergillus spp. that is released into bloodstream by growing hyphae and germinating spores/conidia.…”

Section: Introductionmentioning

confidence: 99%

Galactomannan testing andAspergillusPCR in same-day bronchoalveolar lavage and blood samples for diagnosis of invasive aspergillosis

et al. 2016

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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 Eigl et al. 529GM (>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.

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Bronchoalveolar Lavage Lateral-Flow Device Test for Invasive Pulmonary Aspergillosis in Solid Organ Transplant Patients

Abstract: To conclude, the LFD test of BAL specimens is performed easily and provides accurate and rapidly available results in patients after SOT. Therefore, this new point-of-care test may be a promising diagnostic approach for detecting IPA using BAL specimens from SOT patients.

Cited by 60 publications

References 40 publications

Novel Tests for Diagnosis of Invasive Aspergillosis in Patients with Underlying Respiratory Diseases

Novel Tests for Diagnosis of Invasive Aspergillosis in Patients with Underlying Respiratory Diseases

Diagnostic accuracy of a novel lateral-flow device in invasive aspergillosis: a meta-analysis

Galactomannan testing andAspergillusPCR in same-day bronchoalveolar lavage and blood samples for diagnosis of invasive aspergillosis

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