Comparative evaluation of galactomannan test with bronchoalveolar lavage and serum for the diagnosis of invasive aspergillosis in patients with hematological malignancies
INTRODUCTION: Invasive pulmonary aspergillosis (IPA) is a major cause of morbidity and mortality in patients with hematological malignancies. In recent years, testing for values of galactomannan (GM) in serum and bronchoalveolar lavage (BAL) fluid has been investigated as a diagnostic test for IPA f...
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| Format: | Article |
| Language: | English |
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Thieme Medical and Scientific Publishers Pvt. Ltd.
2017-10-01
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| Series: | Journal of Laboratory Physicians |
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| Online Access: | http://www.thieme-connect.de/DOI/DOI?10.4103/JLP.JLP_127_16 |
| _version_ | 1811324568656150528 |
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| author | Ankit Gupta Malini R. Capoor Trupti Shende Bhawna Sharma Ritin Mohindra Jagdish Chander Suri Dipender Kumar Gupta |
| author_facet | Ankit Gupta Malini R. Capoor Trupti Shende Bhawna Sharma Ritin Mohindra Jagdish Chander Suri Dipender Kumar Gupta |
| author_sort | Ankit Gupta |
| collection | DOAJ |
| description | INTRODUCTION: Invasive pulmonary aspergillosis (IPA) is a major cause of morbidity and mortality in patients with hematological malignancies. In recent years, testing for values of galactomannan (GM) in 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) cutoffs, especially for BAL galactomannan remains lacking.
METHODS: We performed a prospective case–control study to determine an optimal BAL GM OD cutoff 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 GM results. Exclusion criteria included the use of piperacillin/tazobactam and use of antifungals that were active against Aspergillus spp. before bronchoscopy. There were two control groups: patients with hematological diagnoses not meeting definitions for proven or probable IPA and patients with nonhematological diagnoses with no evidence of aspergillosis. Following bronchoscopy and BAL, GM testing was performed using the Platelia Aspergillus seroassay in accordance with the manufacturer’s instructions.
RESULTS: There were 51 cases and 20 controls. Cases had higher BAL fluid GM OD indices (ODIs) (mean: 1.27 and range: 0.4–3.78) compared with controls (mean: 0.26 and range: 0.09–0.35). Receiver operating characteristic analysis demonstrated an optimum ODI cutoff of 1.0, with high specificity (100%) and sensitivity (87.5%) for diagnosing IPA.
CONCLUSIONS: Our results support BAL GM testing as a reasonably safe test with higher sensitivity compared to serum GM testing in at-risk patients with hematological diseases. A higher OD cutoff is necessary to avoid overdiagnosis of IPA. |
| first_indexed | 2024-04-13T14:16:36Z |
| format | Article |
| id | doaj.art-aea6db6153a54d53a96d66ef18f16d75 |
| institution | Directory Open Access Journal |
| issn | 0974-2727 0974-7826 |
| language | English |
| last_indexed | 2024-04-13T14:16:36Z |
| publishDate | 2017-10-01 |
| publisher | Thieme Medical and Scientific Publishers Pvt. Ltd. |
| record_format | Article |
| series | Journal of Laboratory Physicians |
| spelling | doaj.art-aea6db6153a54d53a96d66ef18f16d752022-12-22T02:43:38ZengThieme Medical and Scientific Publishers Pvt. Ltd.Journal of Laboratory Physicians0974-27270974-78262017-10-0190423423810.4103/JLP.JLP_127_16Comparative evaluation of galactomannan test with bronchoalveolar lavage and serum for the diagnosis of invasive aspergillosis in patients with hematological malignanciesAnkit Gupta0Malini R. Capoor1Trupti Shende2Bhawna Sharma3Ritin Mohindra4Jagdish Chander Suri5Dipender Kumar Gupta6Department of Microbiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IndiaDepartment of Microbiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IndiaDepartment of Microbiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IndiaDepartment of Microbiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IndiaDepartment of Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IndiaDepartment of Respiratory Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IndiaDepartment of Hematology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IndiaINTRODUCTION: Invasive pulmonary aspergillosis (IPA) is a major cause of morbidity and mortality in patients with hematological malignancies. In recent years, testing for values of galactomannan (GM) in 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) cutoffs, especially for BAL galactomannan remains lacking. METHODS: We performed a prospective case–control study to determine an optimal BAL GM OD cutoff 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 GM results. Exclusion criteria included the use of piperacillin/tazobactam and use of antifungals that were active against Aspergillus spp. before bronchoscopy. There were two control groups: patients with hematological diagnoses not meeting definitions for proven or probable IPA and patients with nonhematological diagnoses with no evidence of aspergillosis. Following bronchoscopy and BAL, GM testing was performed using the Platelia Aspergillus seroassay in accordance with the manufacturer’s instructions. RESULTS: There were 51 cases and 20 controls. Cases had higher BAL fluid GM OD indices (ODIs) (mean: 1.27 and range: 0.4–3.78) compared with controls (mean: 0.26 and range: 0.09–0.35). Receiver operating characteristic analysis demonstrated an optimum ODI cutoff of 1.0, with high specificity (100%) and sensitivity (87.5%) for diagnosing IPA. CONCLUSIONS: Our results support BAL GM testing as a reasonably safe test with higher sensitivity compared to serum GM testing in at-risk patients with hematological diseases. A higher OD cutoff is necessary to avoid overdiagnosis of IPA.http://www.thieme-connect.de/DOI/DOI?10.4103/JLP.JLP_127_16bronchoalveolar lavagegalactomannanhematological malignanciesserum |
| spellingShingle | Ankit Gupta Malini R. Capoor Trupti Shende Bhawna Sharma Ritin Mohindra Jagdish Chander Suri Dipender Kumar Gupta Comparative evaluation of galactomannan test with bronchoalveolar lavage and serum for the diagnosis of invasive aspergillosis in patients with hematological malignancies Journal of Laboratory Physicians bronchoalveolar lavage galactomannan hematological malignancies serum |
| title | Comparative evaluation of galactomannan test with bronchoalveolar lavage and serum for the diagnosis of invasive aspergillosis in patients with hematological malignancies |
| title_full | Comparative evaluation of galactomannan test with bronchoalveolar lavage and serum for the diagnosis of invasive aspergillosis in patients with hematological malignancies |
| title_fullStr | Comparative evaluation of galactomannan test with bronchoalveolar lavage and serum for the diagnosis of invasive aspergillosis in patients with hematological malignancies |
| title_full_unstemmed | Comparative evaluation of galactomannan test with bronchoalveolar lavage and serum for the diagnosis of invasive aspergillosis in patients with hematological malignancies |
| title_short | Comparative evaluation of galactomannan test with bronchoalveolar lavage and serum for the diagnosis of invasive aspergillosis in patients with hematological malignancies |
| title_sort | comparative evaluation of galactomannan test with bronchoalveolar lavage and serum for the diagnosis of invasive aspergillosis in patients with hematological malignancies |
| topic | bronchoalveolar lavage galactomannan hematological malignancies serum |
| url | http://www.thieme-connect.de/DOI/DOI?10.4103/JLP.JLP_127_16 |
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