Diagnosis of invasive pulmonary aspergillosis (IPA) probable value of the assay galactomannan (GM) in the BAL in immunocompromised patients

A. LebuissonMT BaixenchJ. Dupouy-Camet, A. paugam

Abstract: 

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
1 liver transplantation Yes

Yes (17.95)

Yes
2 liver transplantation Yes Yes (15,41) Yes
3 liver transplantation No No (0.25) No
4 liver transplant No No (0.24) No
5 Septic shock No

No (0.12)

No
6 Lupus No No (0.07) Yes
7 Lupus Yes Yes (16.5) Yes
8 vasculitis No Yes (1.39) Yes
9 acute myeloid leukemia No No (0.25) No
10 acute myeloid leukemia No Yes (5.1) Yes
11 lymphoma No Yes (1.46) Yes
12 Acute lymphocytic leukemia No

Yes (2.57)

No
13 lymphoma No No (0.08) No
14 lymphoma No

No (0.13)

Yes
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.

2008

Full conference title: 

Réunion Interdisciplinaire de Chimiothérapie Anti Infectieuse
    • RICAI 28th (2008)