The detection of galactomannan in bronchoalveolar lavage as an useful tool for diagnosis of invasive aspergillosis

MT Hedayati1, M Taghizadeh-Armaki 2, H Zarinfar3, V Moqarabzadeh4, S Mahdavi Omran 2, S Saber5, P Verweij6, SM Seyedmousavi1,7

Author address: 

1Invasive Fungi Research Center, Mazandaran University of Medical Sciences, Sari, Iran 2Department of Medical Mycology and Parasitology, School of Medicine, Babol University of Medical Sciences, Babol, Iran 3Department of Medical Mycology and Parasitology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran 4Department of Biostatistics, School of Health Sciences, Mazandaran University of Medical Sciences, Sari, Iran 5School of Medicine, Tehran University of Medical Sciences, Tehran, Iran 6Department of Medical Microbiology, Radboudumc, Nijmegen, The Netherlands 7Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, Maryland, USA

Abstract: 

Purpose: The detection of circulating galactomannan (GM) antigen in serum and 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. In the present study we assessed the Platelia GM index in BAL of patients with proven and probable invasive pulmonary aspergillosis (IPA). Methods: In a prospective study between 2009 and 2014, a total of 116 BAL samples were collected from patients with underlying pulmonary disorders who were suspected to IA from two university hospitals in Tehran, Iran. The Platelia Aspergillus GM EIA (Bio-Rad Laboratories, Marnes-la-Coquette, France) was used to detect the presence of GM on BAL fluid specimens, according to instruction of manufacturer. Results: According to BAL’s GM index ≥ 0.5, of 116 patients, 33 (28.4%) with IPA and 5 (4.3%) cases without IPA had positive results. However, at GM index ≥ 1, of these studied patients, 22 (19.0%) cases had positive results. Ten patients with IA had a GM index ≥ 2, including 2 cases with proven IA. In IA patients with positive GM, the GM index ranged from 0.5 to 6.5. In positive GM cases with a positive culture, the mean of BAL GM Index (1.9) was higher than those of negative cases with a negative culture (0.34). The overall sensitivity and specificity of GM-index considering cut-off value of ≥ 0.5 were 91% and 82% and those of GM index of ≥ 1.0 as 57% and 86%, respectively. The positive and negative predictive values of GM detection in BAL samples for GM index ≥ 0.5 were 47 and 98 and those of GM index ≥ 1 as 44 and 92. The area under the ROC curve for GM-index ≥ 0.5 in all BAL samples was 0.91 (95% CI, 92.1 to 99.8) (P
2018

Full conference title: 

The 8th Advances Against Aspergillus, Lisbon Conference Center, Lisbon, Portugal
    • AAA 8th (2018)