Clinical utility of Aspergillus galactomannan and PCR in bronchoalveolar lavage fluid for the diagnosis of invasive pulmonary aspergillosis in patients with haematological malignancies

被引：53

作者：

Heng, Siow-Chin ^{[1
]}

Chen, Sharon C. -A. ^{[2
,3
,4
]}

Morrissey, C. Orla ^{[5
,6
,7
]}

Thursky, Karin ^{[8
,9
]}

Manser, Renee L. ^{[10
]}

De Silva, Harini D. ^{[7
]}

Halliday, Catriona L. ^{[2
,3
,4
]}

Seymour, John F. ^{[9
,11
]}

Nation, Roger L. ^{[12
]}

Kong, David C. M. ^{[1
,12
]}

Slavin, Monica A. ^{[8
,9
]}

机构：

[1] Monash Univ, Fac Pharm & Pharmaceut Sci, Ctr Med Use & Safety, Parkville, Vic 3052, Australia

[2] Westmead Hosp, ICMPR Pathol West, Ctr Infect Dis, Westmead, NSW 2145, Australia

[3] Westmead Hosp, ICMPR Pathol West, Microbiol Lab Serv, Westmead, NSW 2145, Australia

[4] Univ Sydney, Westmead, NSW 2145, Australia

[5] Alfred Hlth, Dept Infect Dis, Melbourne, Vic 3004, Australia

[6] Monash Univ, Melbourne, Vic 3004, Australia

[7] Burnet Inst, Ctr Biomed Res, Melbourne, Vic 3004, Australia

[8] Peter MacCallum Canc Ctr, Dept Infect Dis, East Melbourne, Vic 3002, Australia

[9] Univ Melbourne, Fac Med, Parkville, Vic 3010, Australia

[10] Peter MacCallum Canc Ctr, Div Canc Med, East Melbourne, Vic 3002, Australia

[11] Peter MacCallum Canc Ctr, Dept Haematol, East Melbourne, Vic 3002, Australia

[12] Monash Univ, Monash Inst Pharmaceut Sci, Parkville, Vic 3052, Australia

来源：

DIAGNOSTIC MICROBIOLOGY AND INFECTIOUS DISEASE | 2014年 / 79卷 / 03期

关键词：

Galactomannan; Aspergillus PCR; Diagnosis; Haematology; REAL-TIME PCR; RANDOMIZED CONTROLLED-TRIAL; CELL TRANSPLANT RECIPIENTS; FUNGAL-INFECTIONS; ANTIGEN-DETECTION; QUANTITATIVE PCR; CANCER-PATIENTS; ASSAY; SAMPLES; RISK;

D O I：

10.1016/j.diagmicrobio.2014.03.020

中图分类号：

R51 [传染病];

学科分类号：

100401 ;

摘要：

Interpretation of Aspergillus galactomannan (GM) and PCR results in bronchoalveolar lavage (BAL) fluid for the diagnosis of invasive pulmonary aspergillosis (IPA) in patients with haematological malignancies requires clarification. A total of 116 patients underwent BAL for investigation of new lung infiltrates: 40% were neutropenic, 68% and 36% were receiving mould-active antifungal agents and beta-lactam antibiotics. The diagnosis of proven IPA (n = 3), probable IPA (n = 15), and possible invasive fungal disease (IFD, n = 50) was made without inclusion of GM results. BAL GM (at cut-off of 0.8) had lower diagnostic sensitivity for IPA than PCR (61% versus 78%) but higher specificity (93% versus 79%). Both tests had excellent negative predictive values (85-90%), supporting their utility in excluding IPA. The use of BAL GM and PCR results increased the certainty of Aspergillus aetiology in 7 probable IPA cases where fungal hyphae were detected in respiratory samples by microscopy, and upgraded 24 patients from possible IFD to probable IPA. Use of BAL GM and PCR improves the diagnosis of IPA. Crown Copyright (C) 2014 Published by Elsevier Inc. All rights reserved.

引用

页码：322 / 327

页数：6

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