Galactomananan assay performance in bronchoalveolar lavage for the diagnosis of invasive Aspergillosis in imunocompromissed hosts

Ref ID: 17553

Author:

MV Batista1,2,3, C Constí¢ncia3, CA Fonseca3, SF Costa1,2, CM Gamba1,2, SV Campos1, IL França1,2, FL Dulley4, GH Fonseca4, MA Shikanai-Yasuda1,2,3

Author address:

1immunocompromised Host Group, FMUSP, São Paulo, Brazil
2Department of Infectious and Parasitic Diseases, FMUSP, São Paulo, Brazil
3 Laboratory of Immunology (LIM 48), FMUSP, São Paulo, Brazil
4Hematology and Stem Cell Transplantation Clinics, FMU

Full conference title:

5th Advances Against Aspergillosis

Date: 26 February 2014

Abstract:

Purpose: Invasive aspergillosis (IA) is a
major cause of morbidity and mortality in immunocompromised patients,
particularly those with hematological malignancies in the setting of profound
neutropenia and/or hematopoietic stem cell transplantation. The diagnosis of IA
in immunocompromised patients is a challenge. Recently, research has shown that
galactomananan (GM) assays are useful in diagnosis, especially when performed
in bronchoalveolar lavage (BAL) where there is a greater sensitivity and
earlier kinetics compared with serum.

Methods: We performed a prospective study
from December 2008 to June 2011 to determine the clinical features and
diagnosis of invasive aspergillosis in 47 immunocompromised patients of the
Hospital das Clí­nicas da Faculdade de Medicina da USP, classified according to
the EORTC criteria as proven, probable or possible IA along with 11 controls
with other diseases such as tuberculosis, herpes, sepsis, febrile neutropenia,
lymphoma and lung cancer . We evaluated the effectiveness of BAL GM assay in
diagnosing IA in these populations.

Results: Four samples were associated with
proven, 15 with probable, and 28 with possible IA and 11 were associated with
no IA. Using BAL GM ≥ 0.8 (cutoff for serum GM) and ≥ 1.00, the sensitivity in
diagnosing proven or probable IPA was 58% (11/19) and 58% (11/19),
respectively, and specificity was 90% (10/11) and 100% (11/11). At these
cutoffs, positive and negative predictive values were 91% (11/12) and 55%
(10/18), and 100% (11/11) and 58% (11/19), respectively. In this study 98%
(56/57) of patients were already receiving antifungal agents for at least 72
hours at time of BAL.

Conclusion: The BAL GM assay appears promising
for the diagnosis of IA. However, treatment with certain antifungals may
interfere with the results of the BAL GM assay.

Abstract Number: 121

Conference Year: 2012

Link to conference website: http://www.advancesagainstaspergillosis.org/2012/index.html

New link: NULL

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