Bronchoalveolar lavage galactomannan for the diagnosis of chronic pulmonary aspergillosis

Izumikawa, Koichi; Yamamoto, Yoshihiro; Mihara, Tomo; Takazono, Takahiro; Morinaga, Yoshitomo; Kurihara, Shintaro; Nakamura, Shigeki; Imamura, Yoshifumi; Miyazaki, Taiga; Nishino, Tomoya; Tsukamoto, Misuzu; Kakeya, Hiroshi; Yanagihara, Katsunori; Mine, Mariko; Yasuoka, Akira; Tashiro, Takayoshi; Kohno, Shigeru

doi:10.3109/13693786.2012.682228

Cited by 66 publications

(60 citation statements)

References 25 publications

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“…Two reports evaluated the usefulness of the GM test on BALF for CPA diagnosis. Using an ODI of 0.7, Izumikawa et al reported that sensitivity and specificity were 72.2% and 77.0%, respectively (11). In this study, sensitivity and specificity with an ODI of 0.5 were 77.8% and 90.0%, respectively.…”

Section: Discussionsupporting

confidence: 52%

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Usefulness of Two Aspergillus PCR Assays and Aspergillus Galactomannan and β- d -Glucan Testing of Bronchoalveolar Lavage Fluid for Diagnosis of Chronic Pulmonary Aspergillosis

et al. 2017

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We evaluated the usefulness of an Aspergillus galactomannan (GM) test, a ␤-D-glucan (␤DG) test, and two different Aspergillus PCR assays of bronchoalveolar lavage fluid (BALF) samples for the diagnosis of chronic pulmonary aspergillosis (CPA). BALF samples from 30 patients with and 120 patients without CPA were collected. We calculated the sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio for each test individually and in combination with other tests. The optical density index values, as determined by receiver operating characteristic analysis, for the diagnosis of CPA were 0.5 and 100 for GM and ␤DG testing of BALF, respectively. The sensitivity and specificity of the GM test, ␤DG test, and PCR assays 1 and 2 were 77.8% and 90.0%, 77.8% and 72.5%, 86.7% and 84.2%, and 66.7% and 94.2%, respectively. A comparison of the PCR assays showed that PCR assay 1 had a better sensitivity, a better negative predictive value, and a better negative likelihood ratio and PCR assay 2 had a better specificity, a better positive predictive value, and a better positive likelihood ratio. The combination of the GM and ␤DG tests had the highest diagnostic odds ratio. The combination of the GM and ␤DG tests on BALF was more useful than any single test for diagnosing CPA.KEYWORDS chronic pulmonary aspergillosis, Aspergillus galactomannan test, ␤-D-glucan test, Aspergillus PCR assays T he Aspergillus spp. are ubiquitous saprophytic fungi and are the pathogens most commonly responsible for pulmonary fungal disease worldwide. They cause a variety of diseases, including invasive and chronic aspergillosis and allergic disease (1). Chronic pulmonary aspergillosis (CPA) is classified into three major subtypes: chronic necrotizing pulmonary aspergillosis, chronic cavitary pulmonary aspergillosis, and chronic fibrosing pulmonary aspergillosis (2). However, these subtypes usually overlap and are difficult to differentiate clinically. Thus, many investigators refer to these subtypes merely as CPA (3)(4)(5)(6)(7)(8).CPA is a slowly progressive pulmonary syndrome caused by Aspergillus spp. It is saprophytic in persons with underlying pulmonary conditions such as old tuberculosis, pulmonary emphysema, and previous thoracic surgery (9). CPA is diagnosed by evaluating clinical symptoms, radiological findings, and the results from serum Aspergillus antibody testing and Aspergillus sp. culture. These diagnostic criteria are based on a

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Section: Discussionsupporting

confidence: 52%

“…Although GM in BALF was reported to be useful for the diagnosis of CPA (11,12), a clear cutoff value has not been established. ␤-D-Glucan (␤DG) is a component of the cell walls of all fungi except zygomycetes.…”

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confidence: 99%

Usefulness of Two Aspergillus PCR Assays and Aspergillus Galactomannan and β- d -Glucan Testing of Bronchoalveolar Lavage Fluid for Diagnosis of Chronic Pulmonary Aspergillosis

et al. 2017

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“…The sensitivity and specificity of galactomannan Aspergillus antigen (GM) assay in bronchoalveolar lavage (BAL) fluid specimens was 77.2% and 77.0%, respectively (with a cut-off level of 0.4), and in serum was 66.7% and 63.5%, respectively, with serum at a cut-off level of 0.7 for the diagnosis of CPA [38]. In another study the BAL GM-antigen detection test had a sensitivity and specificity of 85.7% and 76.3%, respectively, with a cut-off level of >0.5 [28].…”

Section: Contribution Of Galactomannan Antigen To the Diagnosis Of Cpamentioning

confidence: 99%

Chronic pulmonary aspergillosis: rationale and clinical guidelines for diagnosis and management

Denning¹,

Cadranel²,

et al. 2015

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Chronic pulmonary aspergillosis (CPA) is an uncommon and problematic pulmonary disease, complicating many other respiratory disorders, thought to affect ∼240 000 people in Europe. The most common form of CPA is chronic cavitary pulmonary aspergillosis (CCPA), which untreated may progress to chronic fibrosing pulmonary aspergillosis. Less common manifestations include: Aspergillus nodule and single aspergilloma. All these entities are found in non-immunocompromised patients with prior or current lung disease. Subacute invasive pulmonary aspergillosis (formerly called chronic necrotising pulmonary aspergillosis) is a more rapidly progressive infection (<3 months) usually found in moderately immunocompromised patients, which should be managed as invasive aspergillosis. Few clinical guidelines have been previously proposed for either diagnosis or management of CPA. A group of experts convened to develop clinical, radiological and microbiological guidelines. The diagnosis of CPA requires a combination of characteristics: one or more cavities with or without a fungal ball present or nodules on thoracic imaging, direct evidence of Aspergillus infection (microscopy or culture from biopsy) or an immunological response to Aspergillus spp. and exclusion of alternative diagnoses, all present for at least 3 months. Aspergillus antibody (precipitins) is elevated in over 90% of patients. Surgical excision of simple aspergilloma is recommended, if technically possible, and preferably via video-assisted thoracic surgery technique. Long-term oral antifungal therapy is recommended for CCPA to improve overall health status and respiratory symptoms, arrest haemoptysis and prevent progression. Careful monitoring of azole serum concentrations, drug interactions and possible toxicities is recommended. Haemoptysis may be controlled with tranexamic acid and bronchial artery embolisation, rarely surgical resection, and may be a sign of therapeutic failure and/or antifungal resistance. Patients with single Aspergillus nodules only need antifungal therapy if not fully resected, but if multiple they may benefit from antifungal treatment, and require careful follow-up. @ERSpublications ERS and ESCMID guideline for the management of chronic pulmonary aspergillosis released

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“…In clinical practice, GM index evaluation in BAL has been encouraged as a suitable assessment for early diagnosis of IA in patients with various underlying disorders [22][23][24][25].…”

Section: Discussionmentioning

confidence: 99%

Effect of involved Aspergillus species on galactomannan in bronchoalveolar lavage of patients with invasive aspergillosis

Armaki

Hedayati

Moqarabzadeh

et al. 2017

Journal of Medical Microbiology

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Purpose. The detection of galactomannan (GM) in bronchoalveolar lavage (BAL) fluid is an important surrogate marker for the early diagnosis and therapeutic monitoring of invasive aspergillosis (IA), regardless of the involved species of Aspergillus. Here, we utilized the Platelia Aspergillus GM enzyme immunoassay (Bio-Rad) to evaluate the GM index in BAL fluid samples from patients with proven, probable or putative IA due to Aspergillusflavus versus Aspergillusfumigatus.Methodology. In a prospective study between 2009 and 2015, 116 BAL samples were collected from suspected IA patients referred to two university hospitals in Tehran, Iran.Key findings. According to European Organization for Research and Treatment of Cancer and Mycoses Study Group and Blot criteria, 35 patients were classified as IA patients, of which 33 cases tested positive for GM above 0.5 and, among these patients, 22 had a GM index !1. Twenty-eight were culture positive for A. flavus and seven for A. fumigatus. The GM index for A. flavus cases was between 0.5-6.5 and those of A. fumigatus ranged from 1 to 6.5. The sensitivity and specificity of a GM index !0.5 in cases with A. flavus were 86 and 88 % and for A. fumigatus patients were 100 and 73 %, respectively.Conclusion. Overall, the mean GM index in patients with A. fumigatus (3.1) was significantly higher than those of A. flavus (1.6; P-value=0.031) and the sensitivity of GM lower for A. flavus when compared to A. fumigatus. This finding has implications for diagnosis in hospitals and countries with a high proportion of A. flavus infections.

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Bronchoalveolar lavage galactomannan for the diagnosis of chronic pulmonary aspergillosis

Cited by 66 publications

References 25 publications

Usefulness of Two Aspergillus PCR Assays and Aspergillus Galactomannan and β- d -Glucan Testing of Bronchoalveolar Lavage Fluid for Diagnosis of Chronic Pulmonary Aspergillosis

Usefulness of Two Aspergillus PCR Assays and Aspergillus Galactomannan and β- d -Glucan Testing of Bronchoalveolar Lavage Fluid for Diagnosis of Chronic Pulmonary Aspergillosis

Chronic pulmonary aspergillosis: rationale and clinical guidelines for diagnosis and management

Effect of involved Aspergillus species on galactomannan in bronchoalveolar lavage of patients with invasive aspergillosis

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