Bronchoalveolar lavage galactomannan in the diagnosis of invasive pulmonary aspergillosis among solid organ transplant recipients
Author:
Clancy CJ, Jaber RA, Leather HL, Wingard JR, Staley B, Wheat LJ, Cline CL, Rand KH, Schain D, Baz M, Nguyen MH
Date: 24 April 2007
Abstract:
We review the experience at our institution with galactomannan (GM) testing of bronchoalveolar lavage (BAL) fluid in the diagnosis of invasive pulmonary aspergillosis (IPA) among solid organ transplant recipients. Among 81 patients for whom BAL GM was ordered (heart, n=24; kidney, n=22; liver, n=19; lung, n=16), there were five cases of proven or probable IPA. All five patients had BAL GM >/= 2.1 and survived following antifungal therapy. The sensitivity, specificity, positive and negative predictive values for BAL GM at a cut-off >/= 1.0 were 100%, 90.8%, 41.7% and 100%, respectively. The sensitivity of BAL GM was better than conventional tests such as serum GM or BAL cytology and culture. Moreover, a positive BAL GM diagnosed IPA several days to four weeks before other methods in three patients. Twelve patients had BAL GM >/= 0.5 but no evidence of IPA. Among these, lung transplant recipients accounted for 41.7% (5/12) of the false positive results, reflecting frequent colonization of airways in this population. Excluding lung transplants, the specificity and positive predictive value for other solid organ transplants increased to 92.9% and 62.5%, respectively (cut-off >/= 1.0). In conclusion, BAL GM facilitated more rapid diagnoses of IPA and institution of antifungal therapy among non-lung solid organ transplant recipients, and helped to rule-out IPA.
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