Aspergillus-PCR in bronchoalveolar lavage for detection of invasive fungal disease in immunocompromised patients

Ref ID: 18413

Author:

Michael Buess, Gieri Cathomas, Jörg Halter, Lilian Junker,
Peter Grendelmeier, Michael Tamm, Daiana Stolz

Author address:

Clinic for Pulmonary
Medicine and Respiratory Cell Research, University Hospital Basel, Basel,
Switzerland; Department of Microbiology, Kanton Hospital Liestal, Liestal,
Switzerland; Clinic for Hematology, University Hospital Basel, Basel,
Switze

Full conference title:

European Respiratory Congress

Abstract:

Introduction: Invasive fungal disease (IFD) is a frequent and serious infectious
complication in neutropenic patients. We evaluated the diagnostic accuracy of
conventional nested PCR in the bronchoalveolar fluid to diagnose IFD in severe
immunocompromised patients.
Methods: 191 consecutive patients undergoing bronchoscopy for suspected pulmonary
infection were included. The probability of IFD was estimated according
to the standard EORTC/NIAID classification and on clinical grounds as independently
assessed by a pulmonary specialist and hematologist. Conventional nested
PCR to detect aspergillus fumigatus, flavus, niger, glaucus, terreus and tomarrii
were applied to 2 ml bronchoalveolar fluid.
Results: Mean age was 50.5 y (19-80), 116 were male. There were 129 patients
with hematological conditions, 26 solid organ transplant recipients, 24 autoimmune
disorders, and 12 HIV. A total of 111 (58.1%) of the patients were on
anti-fungal therapy at the time of bronchoscopy. According to the EORTC/NIAID
classification, 2 (1%) had proven, 8 (4.2%) probable, 43 (22.5%) possible and 138
(72.3%) no IFD. Nested PCR for Aspergillus was positive in 55 cases (28.8%) –
0/2 in proven, 4/8 in probable, 10/43 in possible and 41/138 in no IFD. Anti-fungal
therapy did not significantly influenced PCR results (p=0.749). Irrespective of the
EORT/NIAID criteria, there was a strong clinical suspicion of IFD in 53 (27.7%)
cases. From those, only 15 (28.3%) had a positive nested PCR.
Conclusion: Conventional nested aspergillus PCR in the bronchoalveolar lavage
seems to be of limited usefulness for detection of invasive fungal disease in
immunocompromised patients.

Abstract Number: P2518

Conference Year: 2011

Link to conference website: http://www.ers-education.org/ersMade/abstract_print_11/files/Abstract_book_2011.pdf

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