Galactomannan testing in bronchoalveolar lavage fluid facilitates the diagnosis of invasive pulmonary aspergillosis and is not influenced by short-course antifungal therapy,

M.A. Jantz, MD1, V. Kulkarni, MD2, H. Nguyen, MD3, J. Wingard, MD2, C. Cline, MD2, S. Fernandez-Bussy, MD1

Author address: 

1Gainesville, FL/US, 2Gainesville/US, 3Pittsburgh/US

Abstract: 

Abstract. Background: Invasive pulmonary aspergillosis (IPA) is a major cause of mortality in patients with stem cell transplants and hematologic malignancies. Timely diagnosis of IPA improves survival but is difficult to make. Methods: We evaluated the effectiveness of BAL galactomannan (GM) in diagnosing IPA in these patient populations by retrospectively reviewing records of patients in whom BAL GM testing was performed. Results: 8 patients had proven, 13 probable and 31 possible invasive fungal infections (IFI), and 37 had no IFI. Among the IFI patients, 4 had proven, 12 probable and 31 possible IPA. Using a BAL GM cut-off of 0.5, the sensitivity and specificity in diagnosing proven or probable IPA were 75% and 89%, respectively. BAL GM results were not impacted by short-courses of mould-active antifungal agents. We did not find any correlation between BAL and serum GM values. BAL GM testing added sensitivity to serum GM and BAL culture. BAL GM indices were higher among patients who died within 6 weeks of IPA diagnosis (median: 6.64) than those who survived (median: 0.85; p=0.02). Conclusion: BAL GM added sensitivity to serum GM and other bronchoscopic means for diagnosing IPA. Our study suggests that BAL GM might be useful as a surrogate endpoint for treatment, but this needs to be validated by larger studies Am J Respir Crit Care Med 181;2010:A3199
2010

abstract No: 

Poster Board # E58

Full conference title: 

American Thoracic Society International Conference
    • ATS 2010