Comparison of Serum and Bronchoalveolar Lavage Galactomannan in Diagnosing Invasive Aspergillosis in Solid-Organ Transplant Recipients

Abstract

Objectives: This study sought to compare the sensitivities of serum galactomannan and bronchoalveolar lavage galactomannan in diagnosing invasive aspergillosis in solid-organ transplant recipients (lung and heart). Materials and Methods: This study took place in the lung transplant center of the National Research Institute for Tuberculosis and Lung Disease. All patients with clinical and radiologic manifestations suggestive of pulmonary infection were included. Serum and bronchoalveolar lavage galactomannan were measured. Results: Seventeen patients were included (lung, 15; heart, 1; heart-lung, 1). Probable or definite invasive aspergillosis was diagnosed in 9 patients. With a cutoff ≥ 0.5, serum galactomannan sensitivity and specificity for diagnosing invasive aspergillosis were 77.18% and 100%. Negative predictive value and positive predictive value were 80% and 100%. The sensitivity and specificity of bronchoalveolar lavage galactomannan for diagnosing invasive aspergillosis with cutoff of ≥ 0.5 was 100%. Conclusions: Regarding the high levels of mortality and problems in diagnosing this disease, using bronchoalveolar lavage galactomannan could be a suitable option.

Phase II Study on Voriconazole for Treatment of Chinese Patients with Malignant Hematological Disorders and Invasive Aspergillosis

“…However, limitations of biopsy make it applicable only to part of patients . In recent years, with a widespread application of serum GM and aspergillus fluorescent PCR tests, early diagnosis of aspergillosis is significantly improved (Springer et al, 2012;Tabarsi et al, 2012). GM test is a method which adopts serum enzyme-linked immunosorbent assay to detect aspergillus galacto-glucomannan antigens, to confirm a diagnosis of aspergillosis (Godet et al, 2012;Reinwald et al, 2012;Stopiglia et al, 2012;Tabarsi et al, 2012).…”

“…In recent years, with a widespread application of serum GM and aspergillus fluorescent PCR tests, early diagnosis of aspergillosis is significantly improved (Springer et al, 2012;Tabarsi et al, 2012). GM test is a method which adopts serum enzyme-linked immunosorbent assay to detect aspergillus galacto-glucomannan antigens, to confirm a diagnosis of aspergillosis (Godet et al, 2012;Reinwald et al, 2012;Stopiglia et al, 2012;Tabarsi et al, 2012). The sensitivity of GM test was 50-90% and the specificity was 80-90%, and usually demonstrating positive before the emergence of radiological evidence (Horbrecht et al, 2002;Georgiadou et al, 2012).…”

Laboratory Diagnosis of Invasive Aspergillosis: From Diagnosis to Prediction of Outcome

“…Cordonnier et al have recently shown that amongst haematology patients with neutrophils levels <0.1 × 10 9 /L are more likely to have higher serum GM levels than patients with higher neutrophil levels [191]. The serum GM assay has been shown to be modestly sensitive in COPD patients with IA [192, 193] and poorly sensitive in solid organ transplantation [194, 195] though more recent studies have achieved greater sensitivities in this patient group [196]. The lower incidence of neutropenia in these two patient groups may well account in part for the reduced sensitivity of the serum GM assay.…”

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

“…Aspergillus GM antigen detection in serum and bronchoalveolar lavage (BAL) fluid by the Bio-Rad Platelia sandwich enzyme immunoassay (EIA, Bio-Rad) has been studied extensively [12,13]. Several previous studies have also evaluated the GM assay in BAL samples in various patient groups and conditions; they reported a higher parallel sensitivity and specificity in comparison to serum specimens [14][15][16]. According to the revised European Organization for Research and Treatment of Cancer and Mycoses Study Group (EORTC/MSG) diagnostic criteria, a positive BAL GM test is a mycological criterion of IA in association with host and clinical or radiological findings [17].…”