A prospective comparison of galactomannan in bronchoalveolar lavage fluid for the diagnosis of pulmonary invasive aspergillosis in medical patients under intensive care: comparison with the diagnostic performance of galactomannan and of (1→ 3) – β – d-glucan chromogenic assay in serum samples

Abstract

Diagnosis of fungal pneumonia (FP) in critically ill patients is challenging. Circulating biomarkers for the diagnosis of FP have limitations and the combination of different assays in serum samples and directly from the target organ may further improve the diagnosis of FP. We prospectively assessed the diagnostic utility of paired galactomannan (GM) in bronchoalveolar lavage fluid (BAL) and serum GM and (1→3)-β-D-glucan (BG) assays in critically ill patients at risk of FP. Patients with FP were classified according to European Organisation for Research and Treatment of Cancer-Mycoses Study Group criteria, with modifications. Out of 847 admissions, 51 patients were eligible. There were nine invasive aspergillosis (IA) cases (four proven, five probable), three proven Pneumocysitis jirovecii pneumonia (PJP) cases and one mixed FP case (probable IA and proven PJP). The diagnostic accuracy as given by the area under the receiver operating characteristic curve in IA cases (proven and probable) for GM in BAL was 0.98 (95% CI, 0.94-1.00), whilst for GM and BG in serum it was 0.85 (95% CI, 0.74-0.96) and 0.815 (95% CI, 0.66-0.96), respectively. For IA cases (proven and probable) AUC for GM in BAL was significantly higher than GM and BG in serum (p 0.025 and p 0.032, respectively). In one of four proven and one of six probable IA cases, GM in serum remained negative, whereas GM in BAL was positive. In patients with IA, GM (90%) and BG (80%) appeared a mean of 4.3 days (range, 1-10 days) before Aspergillus was cultured. GM detection in BAL appears to improve the diagnosis of IA in critical patients.

Value of β-d-glucan and Candida albicans germ tube antibody for discriminating between Candida colonization and invasive candidiasis in patients with severe abdominal conditions

“…This finding is clinically relevant not only for the population to which the prediction rule can be applied, but also because it is very easy to remember and may help intensivists to decide when to start antifungal treatment. A few studies have investigated the predictive value of BDG on IC in non-neutropenic critically ill patients [21][22][23][24][25]. Elevated concentrations of BDG have been reported to be associated with other fungi, such as Pneumocystis jirovecii infections [26], Gram-positive and Gram-negative bloodstream infections, exposure to gauze or other materials that contain glucans, biofilms on vascular catheters, hemodialysis, and administration of a,b Superscripts indicate significant differences (P \ 0.05) among rates of BDG and positive CAGTA values among the three study groups Fig.…”

“…The reason for ICU admission was medical in 18.8 % of patients, surgical in 76.1 %, and trauma in 5.1 %. The median (IQR) length of ICU and hospital stay was 15 (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27) and 38 (24-57) days, respectively, which were significantly higher in patients with IC compared to the other two groups. ICU and hospital crude mortality rates were 26.7 and 32.4 %, respectively.…”

Invasive Aspergillosis in Intensive Care Unit Patients in Iran

“…This results show that the detection of GM in BAL fluid enhances the identification of Aspergillus species as a cause of pulmonary disease in ICU patients. The result of several studies have also shown that the GM analysis of BAL samples should consider for IA diagnosis among high-risk patients, especially for the ease of processing and the more rapid result than traditional methods (1,23,29). Moreover, all patients with probable IA had at least one positive BAL GM index, in the present study.…”

Evaluación del rendimiento de 1,3-β-d-glucano como apoyo diagnóstico de infecciones invasoras por Candida spp. en pacientes críticos adultos

“…Así, se ha reportado su positivización precoz antes del inicio de los síntomas o de los signos radiológicos de EFI [9][10][11][12] . Este test también se ha evaluado en pacientes cursando una infección por Pneumocystis jiroveci donde se observan concentraciones elevadas de BDG, con alta sensibilidad y buen valor predictor positivo 17,18 . Existen pocos datos sobre el rendimiento de la medición del BDG en pacientes críticos.…”