Method: we analyzed retrospectively over a 25 month period (01/01 / 2006-08 / 02 /2008) , dosages of GM Aspergillus (Aspergillus Platelia, BioRad) LBA 355 from 313 immunocompromised patients.
Results: According to the diagnostic criteria EORTC, we diagnosed 16 cases of probable API (Table I); no proven API, possible API was not considered.
Table I: Results of diagnostic tests performed on the LBA 16 probable cases of API and type of immunosuppression of the patient.
|Patient (No.)||Nature of immunosuppression||Microscopy: Filament direct||GM detection (ng / ml) Threshold 0.5 ng / ml||Culture: Aspergillus fumigatus|
|2||liver transplantation||Yes||Yes (15,41)||Yes|
|3||liver transplantation||No||No (0.25)||No|
|4||liver transplant||No||No (0.24)||No|
|9||acute myeloid leukemia||No||No (0.25)||No|
|10||acute myeloid leukemia||No||Yes (5.1)||Yes|
|12||Acute lymphocytic leukemia||No||
|15||Chronic lymphocytic leukemia||No||Yes (0.88)||No|
|16||acute myeloid leukemia||Yes||Yes (19.64)||No|
Discussion: Comparing the sensitivity of tests performed on the LBA GM assay appears as having the best diagnostic sensitivity of API likely 56%, the sensitivity of culture is 50% and that of the examination microscopic 25%. GM and / or cultivation combination increases the sensitivity to 62.5%. The specificity of the GM assay for diagnosis of probable API is 97.6% (7/297). It is noteworthy that among the 7 "false" positives detected, one of them could match a possible aspergillosis.
Conclusion: GM assay in BAL of API risk patients appears as a diagnostic test significantly more sensitive than direct microscopy and excellent specificity allows to consider its systematic implementation in patients at risk.
Full conference title:
- RICAI 28th (2008)