A prospective comparison of galactomannan in bronchoalveolar lavage fluid for the diagnosis of pulmonary invasive aspergillosis in medical patients under intensive care: comparison with the diagnostic performance of galactomannan and of (1→ 3) – β – d-glucan chromogenic assay in serum samples

Abstract Background Aspergillus spp. induce elevated levels of several cytokines, including Interleukin (IL)-6 and IL-8. It remains unknown whether these cytokines hold value for clinical routine and enhance diagnostic performances of established and novel biomarkers/molecular tests for invasive aspergillosis (IA) in patients receiving mold-active antifungals. Methods This cohort study included 106 prospectively enrolled (2014–2017) adult cases with underlying hematological malignancies and suspected pulmonary infection undergoing bronchoscopy. Serum samples were collected within 24 hours of bronchoalveolar lavage fluid (BALF) sampling. Both serum and BALF samples were used to evaluate diagnostic performances of the Aspergillus-specific lateral-flow device test (LFD), Aspergillus PCR, galactomannan, β-d-glucan, and cytokines that have shown significant associations with IA in our previous matched case–control analysis (including IL-6 and IL-8), for IA classified according to the revised EORTC/MSG criteria. Results Among the 106 cases, 11 had probable IA, 32 possible IA, and 63 no evidence for IA; 80% received mold-active antifungals at the time of sampling. Diagnostic tests and biomarkers showed significantly better performance in BALF compared with blood, with the exception of serum IL-8 which was highly specific for IA and proved to be the most reliable blood biomarkers. Combinations of serum IL-8 with either BALF LFD (sensitivity 100%, specificity 94%) or BALF PCR (sensitivity 91%, specificity 97%) were highly sensitive and specific for differentiating probable IA from no IA. Conclusion High serum IL-8 levels were highly specific, and when combined with either the BALF Aspergillus-specific LFD, or BALF Aspergillus PCR also highly sensitive for diagnosis of IA. Disclosures G. Johnson, OLM Diagnostics: Employee, Salary.

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Evaluation of Aspergillus-Specific Lateral-Flow Device Test Using Serum and Bronchoalveolar Lavage Fluid for Diagnosis of Chronic Pulmonary Aspergillosis

Journal of Clinical Microbiology ◽

10.1128/jcm.00095-19 ◽

2019 ◽

Vol 57 (5) ◽

Cited By ~ 3

Author(s):

Takahiro Takazono ◽

Yuya Ito ◽

Masato Tashiro ◽

Keitaro Nishimura ◽

Tomomi Saijo ◽

...

Keyword(s):

Bronchoalveolar Lavage ◽

Bronchoalveolar Lavage Fluid ◽

Point Of Care ◽

Invasive Pulmonary Aspergillosis ◽

Antibody Test ◽

Lavage Fluid ◽

Serum Samples ◽

Pulmonary Aspergillosis ◽

Flow Device ◽

Chronic Pulmonary Aspergillosis

ABSTRACT The Aspergillus-specific lateral-flow device (AspLFD) test is a newly developed point-of-care diagnostic method for invasive pulmonary aspergillosis. However, evidence of the diagnostic performance of the AspLFD for chronic pulmonary aspergillosis (CPA) is limited. Therefore, we conducted a retrospective study to investigate this in comparison with the galactomannan (GM) β-d-glucan (BDG) test. Fifty patients with chronic pulmonary aspergillosis and 65 patients with respiratory disease, as a control, were enrolled in this study. The majority of the CPA disease entities were chronic pulmonary aspergillosis (64.0%, n = 32), followed by subacute invasive pulmonary aspergillosis (IPA) (20.0%, n = 10) and simple pulmonary aspergilloma (SPA) (16.0%, n = 8). The sensitivity and specificity of the AspLFD test in serum samples were 62.0% and 67.7%, respectively. The GM test (cutoff index, 1.54) showed a sensitivity of 22% and a specificity of 92.3%, while the sensitivity and specificity of the BDG test (cutoff, 19.3 pg/ml) were 48% and 90.8%, respectively. In bronchoalveolar lavage fluid samples, the AspLFD test showed a sensitivity of 66.7% and a specificity of 69.2%, while those of the GM test (cutoff index, 0.6) were 72.7% and 83.1%, respectively. The Aspergillus precipitating antibody test had 70% sensitivity. Unlike the Aspergillus precipitating antibody test, the AspLFD on serum samples showed similar sensitivity to non-fumigatus Aspergillus species. Patients with false-positive results for the AspLFD on serum samples were of a significantly higher age and had a higher prevalence of cavitary lesions in chest computed tomography than patients with negative results in the control group. Given the results in this study, the performance of the AspLFD using serum was acceptable as a point-of-care test for the diagnosis of CPA.

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