Quantitative Real-Time PCR and Platelia Galactomannan Assay for the Diagnosis of Invasive Pulmonary Aspergillosis: Bronchoalveolar Lavage Fluid Performs Better Than Serum in Non-neutropaenic Patients

Zhang, Shuzhen; Wang, Si-Bu; Wan, Zhe; Que, Chengli; Li, Ruoyu; Yu, Jin

doi:10.1007/s11046-016-0024-5

Cited by 18 publications

(14 citation statements)

References 30 publications

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“…The validity of other, non‐culture‐based methods for the detection of Aspergillus has gained traction over recent years, such that current proposals for the second revision of the EORTC/MSG definitions for IMI include consideration of Aspergillus PCR assays . PCR‐based assays have a wide range of reported sensitivities and have been suggested as a way to improve diagnostic accuracy when combined with other modalities, detect azole resistance and guide judicious use of preemptive antifungal treatment . Grancini et al suggested that BAL real‐time PCR, when performed in conjunction with routine BAL culture and GM, can have a NPV of 99% in immunocompromised patients, while Hoenigl et al reported 100% sensitivity and 98% specificity when combining PCR with GM.…”

Section: Discussionmentioning

confidence: 99%

False positive bronchoalveolar lavage galactomannan: Effect of host and cut‐off value

Farmakiotis

Weiss

et al. 2018

Mycoses

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Summary Objectives Bronchoalveolar lavage galactomannan (BAL‐GM) is a mycological criterion for diagnosis of probable invasive aspergillosis (IA) per European Organization for Research and Treatment of Cancer/Mycoses Study Group (EORT‐MSG) consensus criteria, but its real‐world positive predictive value (PPV) has not been well‐studied. Our aim was to estimate the PPV of BAL‐GM in a contemporary cohort of patients with positive BAL‐GM. Methods We identified consecutive patients with ≥1 positive BAL‐GM value (index ≥ 0.5) at Brigham and Women's Hospital from 11/2009 to 3/2016. We classified patients as having no, possible, probable, or proven IA, excluding BAL‐GM as mycological criterion. Results We studied 134 patients: 54% had hematologic malignancy (HM), and 10% were solid organ transplant (SOT) recipients. A total of 42% of positive (≥0.5) BAL‐GM results were falsely positive (PPV 58%). The number of probable IA cases was increased by 23% using positive BAL‐GM as mycologic criterion alone. PPV was higher in patients with HM or SOT (P < 0.001) and with use of higher thresholds for positivity (BAL‐GM ≥ 1 vs 1‐0.8 vs 0.8‐0.5: P = 0.002). Conclusions 42% of positive BAL‐GM values were falsely positive. We propose a critical reassessment of BAL‐GM cutoff values in different patient populations. Accurate noninvasive tests for diagnosis of IA are urgently needed.

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Section: Discussionmentioning

confidence: 99%

False positive bronchoalveolar lavage galactomannan: Effect of host and cut‐off value

Farmakiotis

Weiss

et al. 2018

Mycoses

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“…Two GM indexes !0.5 [16,30,31] and !1.0 [7,28,32] for BAL fluid have been proposed for the assessment of GM in diagnosis of IA due to A. fumigatus; however, to the best of our knowledge, data on A. flavus is scarce.…”

Section: Discussionmentioning

confidence: 99%

Effect of involved Aspergillus species on galactomannan in bronchoalveolar lavage of patients with invasive aspergillosis

Armaki

Hedayati

Moqarabzadeh

et al. 2017

Journal of Medical Microbiology

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Purpose. The detection of galactomannan (GM) in bronchoalveolar lavage (BAL) fluid is an important surrogate marker for the early diagnosis and therapeutic monitoring of invasive aspergillosis (IA), regardless of the involved species of Aspergillus. Here, we utilized the Platelia Aspergillus GM enzyme immunoassay (Bio-Rad) to evaluate the GM index in BAL fluid samples from patients with proven, probable or putative IA due to Aspergillusflavus versus Aspergillusfumigatus.Methodology. In a prospective study between 2009 and 2015, 116 BAL samples were collected from suspected IA patients referred to two university hospitals in Tehran, Iran.Key findings. According to European Organization for Research and Treatment of Cancer and Mycoses Study Group and Blot criteria, 35 patients were classified as IA patients, of which 33 cases tested positive for GM above 0.5 and, among these patients, 22 had a GM index !1. Twenty-eight were culture positive for A. flavus and seven for A. fumigatus. The GM index for A. flavus cases was between 0.5-6.5 and those of A. fumigatus ranged from 1 to 6.5. The sensitivity and specificity of a GM index !0.5 in cases with A. flavus were 86 and 88 % and for A. fumigatus patients were 100 and 73 %, respectively.Conclusion. Overall, the mean GM index in patients with A. fumigatus (3.1) was significantly higher than those of A. flavus (1.6; P-value=0.031) and the sensitivity of GM lower for A. flavus when compared to A. fumigatus. This finding has implications for diagnosis in hospitals and countries with a high proportion of A. flavus infections.

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“…There is as yet no consensus on how these tests could be used in the diagnostic strategy, and many issues arise, such as difficulties in the differentiation between infection and colonization [23]. A quantitative measurement of Aspergillus DNA could help on this regard, but this remains to be proved [25]. Aspergillus PCR is expected to be included in the next EORTC/MSG definitions of invasive fungal disease [22, 23].…”

Section: Casementioning

confidence: 99%

A Review of Diagnostic Methods for Invasive Fungal Diseases: Challenges and Perspectives

2017

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Invasive fungal diseases are associated with a high morbidity and mortality, particularly in the context of immunosuppression. Diagnosis of invasive fungal diseases is usually complicated by factors such as poor clinical suspicion and unspecific clinical findings. Access to modern diagnostic tools is frequently limited in developing countries. Here, we describe five real-life clinical cases from a Brazilian tertiary hospital, in order to illustrate how to best select diagnostic tests in patients with different fungal infections.

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Quantitative Real-Time PCR and Platelia Galactomannan Assay for the Diagnosis of Invasive Pulmonary Aspergillosis: Bronchoalveolar Lavage Fluid Performs Better Than Serum in Non-neutropaenic Patients

Cited by 18 publications

References 30 publications

False positive bronchoalveolar lavage galactomannan: Effect of host and cut‐off value

False positive bronchoalveolar lavage galactomannan: Effect of host and cut‐off value

Effect of involved Aspergillus species on galactomannan in bronchoalveolar lavage of patients with invasive aspergillosis

A Review of Diagnostic Methods for Invasive Fungal Diseases: Challenges and Perspectives

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