Diagnosing Invasive Pulmonary Aspergillosis in ICU patients : the role of Bronchoalveolar Lavage Lateral -Flow Device Test

Ref ID: 19479

Author:

M Hoenigl1*, J Prattes1, V Posch1, W Duettmann1, K Seeber1, M Lackner2, R Krause1, C Thornton3,
C Lass-Flörl2

Author address:

1Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, Graz, Austria
2Medical University of Innsbruck, Innsbruck, Austria
3Biosciences, University of Exeter, Exeter, United Kingdom

Full conference title:

6th Advances Against Aspergillosis 2014

Abstract:

Purpose:
Invasive pulmonary aspergillosis (IPA) represents an increasing problem in patients requiring
intensified medical care. Due to the crude mortality of 80-90% in absence of adequate treatment,
timely diagnosis and early start of antifungal therapy are key factors in successful treatment of IPA.
The Lateral- Flow Device (LFD) test is a single sample point-of-care test for native BAL testing
that is based on the detection of an Aspergillus extracellular glycoprotein antigen by monoclonal
antibody JF5. This study evaluates the LFD test by using bronchoalveolar lavage (BAL) samples.
Methods:
A total of 91 BAL samples from 87 ICU patients (63 samples from Graz, 24 from Innsbruck) were
included between 2011 and 2013 at the two Austrian University Hospitals of Graz (East of Austria)
and Innsbruck (West of Austria). 12 had probable or proven IPA (8 Graz, 4 Innsbruck). Diagnostic
accuracy of LFD for probable/proven IPA was evaluated. For IPA grading fungal cultures as well as
BAL GM (cut-off 1.0) were used.
Results:
Sensitivity and specificity of LFD test for probable/proven IPA was 67% (Graz 75%, Innsbruck
50%) and 92.4% (Graz 90%, Innsbruck 95%), respectively. PPV was 57%, NPV 95%. BAL GM
levels were available in 66 samples and significantly lower in patients with negative than in those
with positive LFD result (P <0.001). LFD resulted negative in 4 patients with probable IPA. BAL GM was tested in two of those patients and revealed levels of 3.4 and 0.2.In a total of three patients (including the latter with a BAL GM below the cut-off) BAL culture grew Aspergillus fumigatus. Conclusion: The LFD test of BAL specimens is performed easily in ICU patients and may provide rapidly available decision support whether to initiate antifungal therapy.

Abstract Number: 7

Conference Year: 2014

Link to conference website: http://www.AAA2014.org

New link: NULL

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