Comparative evaluation of galactomannan test with bronchoalveolar lavage (BAL) vs serum for the diagnosis of invasive aspergillosis in patients with hematological malignancies

Ankit Gupta*. M R Capoor, A Kumar, D K Gupta and J C Suri

Author address: 

Vardhaman Mahavir Medical College and Safdarjung Hospital, Delhi, India-110 029

Abstract: 

Invasive pulmonary aspergillosis (IPA) is a major cause of morbidity and mortality in patients with hematological malignancies. Recently, galactomannan testing of serum and bronchoalveolar lavage (BAL) fluid has been investigated as a diagnostic test for IPA for such patients, but global experience and consensus on optical density (OD) cut-offs especially for BAL galactomanan remains lacking. We performed a prospective case-control study to determine an optimal BAL galactomannan OD cut-off for IPA in at-risk patients. Cases were subjects with hematological diagnoses who met established revised definitions for proven or probable IPA established by the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group (EORTC/MSG, 2008), without the use of BAL galactomannan results. Exclusion criteria included the use of piperacillin/tazobactam and usage of antifungals that were active against Aspergillus spp. prior to bronchoscopy. There were two control groups: subjects with hematological diagnoses not meeting definitions for proven or probable IPA and subjects with non-hematological diagnoses with no evidence of aspergillosis. Following bronchoscopy and BAL, galactomannan testing was performed using the VdXe& Aspergillus seroassay in accordance with the manufacturer's instructions. There were 25 cases and 20 controls. Cases had higher BAL fluid galactomannan OD indices (mean 1.30, range 0.3-3.0) compared with controls (median 0.5, range 0.2-0.9). ROC analysis demonstrated an optimum OD index cutoff of 1.1, with high specificity and sensitivity for diagnosing IPA. Our results also support BAL galactomannan testing as a reasonably safe test with higher sensitivity compared to serum galactomannan testing in at-risk patients with hematological diseases. Ahigher OD cut-off is necessary to avoid over-diagnosis of IPA. 9830;Corresponding author E-mail: [email protected]
2014

abstract No: 

OP-019

Full conference title: 

Society for Indian Human and Animal Mycologists 2014
    • SIHAM