Diagnosis of Invasive Aspergillosis and Mucormycosis guided by PCR Assays from Bronchoalveolar Lavage Fluid in Allogenic Stem Cell Recipients

Ref ID: 18642

Author:

H. Lellek, MD (Doctor of Medicine) – Doctor1, R. Bialek, Professor – Doctor 2, H.Rohde, H.J.Baumann, H.K.Klose, S.Kluge, N.Kröger, H. Rohde, MD – Doctor 1, H. Baumann, M – Doctor 1, H. Klose, MD – Doctor 1, S. Kluge, MD – Doctor 1, N. Kröger, MD – Pr

Author address:

1Univ. Hosp. Hamburg-Eppendorf, Hamburg, Germany, 2Labor Dr Krause, Hamburg, Germany.

Full conference title:

52nd Annual ICAAC

Date: 9 September 2014

Abstract:

Background: From 2008 to 2011 pulmonary infiltrates were detected by CT-scan in 64 (11,6%) adult patients during allogenic SCT. Methods: All 64 underwent bronchoscopy and the bal fluid obtained was cultured for fungi and galactomannan concentrations were determined. Additionally, DNA was used as a template in two semi-nested PCR assays targeting the mitochondrial DNA of Aspergillus spp. and the 18S ribosomal DNA of Mucorales. Results: Overall PCR assays were positive in 31 (48 %) patients including 3 detected in the follow-up bronchoscopy. Thus, in total Aspergillus spp. DNA alone was detected in 20 (65%) and only DNA of Mucorales spp in 5 (16%) patients whereas DNA of Aspergillus fumigatus and Rhizomucor spp in 6 (19%).Galactomannan was measured in only 44 of 64 bal fluids and compared to results of the PCR assays. In 22 bals both were concordantly negative. In 11 out of 18 fluids with Aspergillus DNA detected by PCR the galactomannan assay was reported positive. Out of 20 patients with detectable Aspergillus DNA 16 improved under antifungal treatment whereas 4 died. Out of 5 patients with Mucorales spp DNA only two survived whereas 3 out of 6 patients with a mixed infection according to PCR survived. In the fungal PCR-negative group consisting of 33 patients 23 (70%) survived – and only one received a combination of antifungals. Whereas 10 out of 20 patients with Aspergillus DNA in the bal 10 were treated with a combination of antifungals, all but one of 11 patients with detectable Mucorales specific DNA received a combination therapy. Conclusions: Screening bals with the two fungal PCR assays appear to be more sensitive than the galactomannan assay and standard culture technique. Mucorales specific DNA was detected at an early stage in order to increase the success rate of antifungal therapy. However, occurrence of pulmonary infiltrates during allogeneic transplantation is associated with a high case fatality rate and the etiology remains to be determined.

Abstract Number: T-347

Conference Year: 2012

Link to conference website: NULL

New link: NULL

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