Document Detail


Aspergillus galactomannan antigen assay in bronchoalveolar lavage fluid for diagnosis of invasive pulmonary aspergillosis.
MedLine Citation:
PMID:  20833201     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: A recently developed bronchoalveolar lavage (BAL) galactomannan (GM) assay shows promising results. We evaluated the diagnostic performance of this assay and analyzed risk factors for false-positive results.
METHODS: A prospective cohort study was performed in a tertiary hospital over a 9-month period. We reviewed all adult patients who underwent GM assays of BAL. Patients were categorized with proven, probable, or possible invasive pulmonary aspergillosis (IPA) according to revised EORTC/MSG definitions. Each patient with a false-positive BAL GM result was matched with three patients with true-negative BAL GM result, and the risk factors for false-positive BAL GM results were determined.
RESULTS: Of 359 enrolled patients, 22 (6%) were diagnosed with IPA (1 proven, 17 probable, and 4 possible). Of the 22 patients with IPA, 17 (77%) had already received antifungal agents before the BAL GM assay was conducted. At an index cutoff value of ≥0.5, the BAL GM assay had a sensitivity of 64% (95% CI 41%-83%) and a specificity of 89% (95% CI 85%-92%). However, at an index cutoff value of ≥0.2, the BAL GM assay had a sensitivity of 86% (95% CI 65%-97%) and a specificity of 74% (95% CI 69%-79%). Of the 52 patients with positive BAL GM assay (≥0.5), 25 (7%) were false-positives. Univariate and multivariate analysis revealed that treatment with piperacillin-tazobactam or ampicillin-sulbactam was associated with false-positive BAL GM results.
CONCLUSIONS: The BAL GM assay appears promising for the diagnosis of IPA. However, treatment with certain antibiotics may interfere with the results of the BAL GM assay.
Authors:
Seong Yeon Park; Sang-Oh Lee; Sang-Ho Choi; Heungsup Sung; Mi-Na Kim; Chang-Min Choi; Sang-Bum Hong; Yeon-Mok Oh; Tae Sun Shim; Younsuck Koh; Yang Soo Kim; Jun Hee Woo; Sung-Han Kim
Publication Detail:
Type:  Evaluation Studies; Journal Article     Date:  2010-09-15
Journal Detail:
Title:  The Journal of infection     Volume:  61     ISSN:  1532-2742     ISO Abbreviation:  J. Infect.     Publication Date:  2010 Dec 
Date Detail:
Created Date:  2010-11-30     Completed Date:  2011-03-02     Revised Date:  2013-01-04    
Medline Journal Info:
Nlm Unique ID:  7908424     Medline TA:  J Infect     Country:  England    
Other Details:
Languages:  eng     Pagination:  492-8     Citation Subset:  IM    
Copyright Information:
Copyright © 2010 The British Infection Association. Published by Elsevier Ltd. All rights reserved.
Affiliation:
Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap-dong, Songpa-gu, Seoul 138-736, Republic of Korea.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Aged, 80 and over
Antigens, Fungal / analysis*
Aspergillus / chemistry,  isolation & purification*
Bronchoalveolar Lavage Fluid / chemistry*,  microbiology
Cohort Studies
False Positive Reactions
Female
Humans
Invasive Pulmonary Aspergillosis / diagnosis*
Male
Mannans / analysis*
Middle Aged
Retrospective Studies
Sensitivity and Specificity
Young Adult
Chemical
Reg. No./Substance:
0/Antigens, Fungal; 0/Mannans; 11078-30-1/galactomannan
Comments/Corrections
Comment In:
J Infect. 2012 Nov;65(5):470-3   [PMID:  22863901 ]
J Infect. 2012 Dec;65(6):588-91   [PMID:  23078908 ]

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