Diagnostic yield of a bronchoalveolar lavage fluid galactomannan assay in patients with negative serum galactomannan results suspected to have invasive pulmonary aspergillosis.

Publisher: Grosse Verlag Country of Publication: Germany NLM ID: 8805008 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1439-0507 (Electronic) Linking ISSN: 09337407 NLM ISO Abbreviation: Mycoses Subsets: MEDLINE

Original Publication: Berlin : Grosse Verlag, [1988?-

Invasive Pulmonary Aspergillosis*/diagnosis; Galactose/*analogs & derivatives ; Mannans/*analysis; Bronchoalveolar Lavage Fluid/chemistry ; Galactose/analysis ; Galactose/blood ; Humans ; Mannans/blood ; Negative Results ; Republic of Korea ; Retrospective Studies ; Sensitivity and Specificity ; Tertiary Care Centers

Background and Objectives: There are limited data in real clinical practice on the diagnostic value of a bronchoalveolar lavage (BAL) fluid galactomannan (GM) assay in patients with suspected invasive pulmonary aspergillosis (IPA) who had negative serum GM results. Thus, we investigated the diagnostic performance of a BAL GM assay in patients with negative serum GM assay results who were suspected to have IPA.
Methods: This retrospective study was performed between May 2008 and April 2019 at a tertiary-care hospital in Seoul, South Korea. All patients with suspected IPA whose serum GM assays revealed negative results who sequentially underwent BAL were enrolled in this study.
Results: A total of 341 patients with suspected IPA including four cases of proven IPA, 38 cases of probable IPA, 107 cases of possible IPA and 192 patients without IPA were enrolled. Of these 341 patients, 107 (31%) with possible IPA were excluded from the final analysis. Of 42 patients with proven and probable IPA who had initial negative serum GM results, 24 (57%) had positive BAL GM results (n = 24) or BAL fungal culture results (n = 8). In addition, BAL revealed evidence of other opportunistic infections including Pneumocystis jirovecii pneumonia (14% [26/190]), cytomegalovirus (CMV) pneumonia (5% [9/188]) and respiratory viral pneumonia (6% [12/193]).
Conclusion: Sequential BAL in patients with suspected IPA who had initial negative serum GM results provided additional diagnostic yield in approximately half of patients with evidence of another co-infection.
(© 2021 Wiley-VCH GmbH.)

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Korea Health Industry Development Institute; HI20C0073 Ministry of Health & Welfare, Republic of Korea

Keywords: antifungal agents; aspergillosis; bronchoalveolar lavage; galactomannan; immunocompromised host; invasive fungal infections; invasive pulmonary aspergillosis; opportunistic infection

0 (Mannans)
11078-30-1 (galactomannan)
X2RN3Q8DNE (Galactose)

Date Created: 20210319 Date Completed: 20220106 Latest Revision: 20220106

20240628

10.1111/myc.13269

33740824