Aspergillus-PCR in bronchoalveolar lavage for detection of invasive pulmonary aspergillosis

GieriCathomas, MafaldaTrippel, Daiana Stolz, Michelle Baumann, Yvonne Knecht, Alois Gratwohl , Michael Tamm

Author address: 

1InstituteofPathology, Kanton Hospital Liestal, Liestal, Switzerland; 2 Clinic of Pulmonary Medicine and Respiratory Cell Research, University Hospital Basel,Basel,Switzerland; 3 Clinic of Hematology, University Hospital Basel, Basel, Switzerland

Abstract: 

Introduction: Invasive pulmonary aspergillosis(IPA)is a frequent and serious infectious complication in neutropenic patients. There is suspicion of IPA if neutropenic patients develop antibiotic resistant fever and pulmonary infiltrates. Culture and cytology in BAL have a high specificity but low sensitivity for the diagnosis of IPA. Methods: We developed a conventional and quantitative PCR to detect aspergillus fumigatus,flavus,niger,glaucus,terreus and tomarrii. BAL samples of 143 patients with pulmonary infection were analysed. Results: There were 50 hematologic patients (leukaemia35, lymphoma15)un- dergoing high dose chemotherapy withorwithoutstemcelltransplantation,36 immunocompromisedpatientsforotherreasons(18solidorgantransplantion,6 HIV,12autoimmunedisease)and22patients withprimarylungdiseases(asthma, bronchiectasis,cysticfibrosis,ABPA).Basedonclinicaldata,CTscanandhistol- ogy 2patientssufferedfromproven,twofromprobable,13frompossibleand33 from noIPAasdefinedbyinternationalguidelines.Therewasaspergilluscoloni- sationorABPAin7cases.Usingthefastprotocoltherewere42positivePCR cases(29.4%),quantitativePCRrevealedapositiveresultin24casesrespectively. A totalof33caseswerepositivebybothnestedPCRsorquantitativePCR(23%). Sensitivity,specificity,PPVandNPVforprovenorprobableIPAinhematologic patients were75.0%,78.3%,23.1%and97.3%respectively. Conclusion: Aspergillus-PCRinBALmightbehelpfultobetterdiagnoseinvasive pulmonaryaspergillosisinimmunocompromisedpatients.DifferentPCRprotocols arecurrentlyevaluatedtodefineoptimaltestconditions.
2008

abstract No: 

2271

Full conference title: 

18th European Respiratory Society Congress
    • ERS 18th (2008)