J Fortún1, P Martín-Dávila2, E Gomez Garcia de la Pedrosa3, J T Silva4, J Garcia-Rodríguez5, D Benito2, E Venanzi2, F Castaño2, M Fernández-Ruiz4, F Lazaro5, R García-Luján6, I Quiles5, J J Cabanillas7, S Moreno2, J M Aguado4. 1. Department of Infectious Diseases, Hospital Universitario Ramon y Cajal, Instituto de Investigación Ramón y Cajal (IRYCIS), Universidad de Alcalá, Madrid, Spain. Electronic address: fortunabete@gmail.com. 2. Department of Infectious Diseases, Hospital Universitario Ramon y Cajal, Instituto de Investigación Ramón y Cajal (IRYCIS), Universidad de Alcalá, Madrid, Spain. 3. Department of Microbiology, Hospital Universitario Ramon y Cajal, Instituto de Investigación Ramón y Cajal (IRYCIS), Universidad de Alcalá, Madrid, Spain. 4. Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre", Universidad Complutense, Madrid, Spain. 5. Department of Microbiology, Hospital Universitario La Paz, Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Universidad Autónoma, Madrid, Spain. 6. Department of Pneumology, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre", Universidad Complutense, Madrid, Spain. 7. Department of Pneumology, Hospital Universitario La Paz, Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Universidad Autónoma, Madrid, Spain.
Abstract
BACKGROUND: The role of galactomannan (GM) in serum or bronchoalveolar lavage fluid (BALF) for the diagnosis of invasive pulmonary aspergillosis (IPA) has been extensively evaluated in hematological patients, however its performance in non-hematological patients is not well established. METHODS: We performed a multicenter retrospective study in 3 university hospitals in Madrid, Spain between 2010 and 2014. The study population comprised patients with chronic obstructive pulmonary disease (COPD) and patients with immunosuppressive conditions in whom IPA was suspected and for whom BALF GM was available. Patients with hematological disorders were excluded. RESULTS: A total of 188 patients (35 with COPD and 153 with immunosuppressive conditions) were analyzed, and 31 cases of IPA (proven or probable) were identified. The global sensitivity of BALF GM (optical density index [ODI] ≥ 1.0) was 77.4%; sensitivity was higher in patients with immunosuppressive conditions than in patients with COPD (81.8% vs 66.7%; p: 0.38). In COPD patients, the best performance was obtained for BALF GM (ODI ≥ 0.5), although sensitivity (88.9%) was similar to that of BALF fungal culture (88.9%). The sensitivity of GM in serum was very poor in both populations (36.4% and 11.6%, respectively). CONCLUSIONS: In the present series, the diagnostic performance of BALF GM was good for IPA in non-hematological patients, especially in patients with immunosuppressive conditions.
BACKGROUND: The role of galactomannan (GM) in serum or bronchoalveolar lavage fluid (BALF) for the diagnosis of invasive pulmonary aspergillosis (IPA) has been extensively evaluated in hematological patients, however its performance in non-hematological patients is not well established. METHODS: We performed a multicenter retrospective study in 3 university hospitals in Madrid, Spain between 2010 and 2014. The study population comprised patients with chronic obstructive pulmonary disease (COPD) and patients with immunosuppressive conditions in whom IPA was suspected and for whom BALF GM was available. Patients with hematological disorders were excluded. RESULTS: A total of 188 patients (35 with COPD and 153 with immunosuppressive conditions) were analyzed, and 31 cases of IPA (proven or probable) were identified. The global sensitivity of BALF GM (optical density index [ODI] ≥ 1.0) was 77.4%; sensitivity was higher in patients with immunosuppressive conditions than in patients with COPD (81.8% vs 66.7%; p: 0.38). In COPDpatients, the best performance was obtained for BALF GM (ODI ≥ 0.5), although sensitivity (88.9%) was similar to that of BALF fungal culture (88.9%). The sensitivity of GM in serum was very poor in both populations (36.4% and 11.6%, respectively). CONCLUSIONS: In the present series, the diagnostic performance of BALF GM was good for IPA in non-hematological patients, especially in patients with immunosuppressive conditions.
Authors: Julie M Steinbrink; Aimee K Zaas; Marisol Betancourt; Jennifer L Modliszewski; David L Corcoran; Micah T McClain Journal: Transl Res Date: 2020-02-20 Impact factor: 7.012