Diagnosis of invasive aspergillosis in hematological malignancy patients: Performance of cytokines, Asp LFD, and Aspergillus PCR in same day blood and bronchoalveolar lavage samples

Heldt, Sven; Prattes, Juergen; Eigl, Susanne; Spieß, Birgit; Flick, Holger; Rabensteiner, Jasmin; Johnson, Gemma; Prüller, Florian; Wölfler, Albert; Niedrist, Tobias; Boch, Tobias; Neumeister, Peter; Strohmaier, Heimo; Krause, Robert; Buchheidt, Dieter; Hoenigl, Martin

doi:10.1016/j.jinf.2018.05.001

Cited by 87 publications

(112 citation statements)

References 39 publications

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“…11 In pediatric recipients with IPA, GM is measurable in peripheral blood. 11 In pediatric recipients with IPA, GM is measurable in peripheral blood.…”

Section: Discussionmentioning

confidence: 99%

The early diagnostic value of serum galactomannan antigen test combined with chest computed tomography for invasive pulmonary aspergillosis in pediatric patients after hematopoietic stem cell transplantation

Qiu

Liao

Huang

et al. 2019

Clinical Transplantation

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Objective The purpose of our study was to evaluate the diagnostic value of serum galactomannan antigen (GM) testing combined with chest computed tomography (CT) of invasive pulmonary aspergillosis (IPA) in pediatric patients after hematopoietic stem cell transplantation. Methods A retrospective nested case‐control study was conducted in the identifying IPA among pediatric patients. Results A total of 141 eligible pediatric recipients with febrile neutropenia were enrolled in this study. All patients in the cases were diagnosed with proven‐probable IPA(PP‐IPA), while only 9 patients in the controls. GM testing was positive in 38 pediatric recipients in the cases and nine recipients in the controls with sensitivity of 62.3%, specificity of 81.8%. Among all patients with IPA, 46 patients in the cases and 9 patients in the controls had typical features of CT imaging with sensitivity of 79.3%, specificity of 85.2%. For discrimination of participants' GM testing combined with CT evaluation, the AUC of the diagnostic model was 0.887 with PPV of 0.764, and NPV of 0.872. Sensitivity was 0.793, and specificity was 0.852 in IPA. Conclusion The combination methods with serum GM and CT scan might be used as a valuable marker for early diagnosis of IPA in pediatric patients after HSCT.

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“…11 In pediatric recipients with IPA, GM is measurable in peripheral blood. 11 In pediatric recipients with IPA, GM is measurable in peripheral blood.…”

Section: Discussionmentioning

confidence: 99%

The early diagnostic value of serum galactomannan antigen test combined with chest computed tomography for invasive pulmonary aspergillosis in pediatric patients after hematopoietic stem cell transplantation

Qiu

Liao

Huang

et al. 2019

Clinical Transplantation

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“…The validity of other, non‐culture‐based methods for the detection of Aspergillus has gained traction over recent years, such that current proposals for the second revision of the EORTC/MSG definitions for IMI include consideration of Aspergillus PCR assays . PCR‐based assays have a wide range of reported sensitivities and have been suggested as a way to improve diagnostic accuracy when combined with other modalities, detect azole resistance and guide judicious use of preemptive antifungal treatment . Grancini et al suggested that BAL real‐time PCR, when performed in conjunction with routine BAL culture and GM, can have a NPV of 99% in immunocompromised patients, while Hoenigl et al reported 100% sensitivity and 98% specificity when combining PCR with GM.…”

Section: Discussionmentioning

confidence: 99%

False positive bronchoalveolar lavage galactomannan: Effect of host and cut‐off value

Farmakiotis

Weiss

et al. 2018

Mycoses

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Summary Objectives Bronchoalveolar lavage galactomannan (BAL‐GM) is a mycological criterion for diagnosis of probable invasive aspergillosis (IA) per European Organization for Research and Treatment of Cancer/Mycoses Study Group (EORT‐MSG) consensus criteria, but its real‐world positive predictive value (PPV) has not been well‐studied. Our aim was to estimate the PPV of BAL‐GM in a contemporary cohort of patients with positive BAL‐GM. Methods We identified consecutive patients with ≥1 positive BAL‐GM value (index ≥ 0.5) at Brigham and Women's Hospital from 11/2009 to 3/2016. We classified patients as having no, possible, probable, or proven IA, excluding BAL‐GM as mycological criterion. Results We studied 134 patients: 54% had hematologic malignancy (HM), and 10% were solid organ transplant (SOT) recipients. A total of 42% of positive (≥0.5) BAL‐GM results were falsely positive (PPV 58%). The number of probable IA cases was increased by 23% using positive BAL‐GM as mycologic criterion alone. PPV was higher in patients with HM or SOT (P < 0.001) and with use of higher thresholds for positivity (BAL‐GM ≥ 1 vs 1‐0.8 vs 0.8‐0.5: P = 0.002). Conclusions 42% of positive BAL‐GM values were falsely positive. We propose a critical reassessment of BAL‐GM cutoff values in different patient populations. Accurate noninvasive tests for diagnosis of IA are urgently needed.

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“…Given the absence of widely accepted criteria for defining IPA in non‐neutropenic patients, studies on new diagnostic tests for IPA focus mostly on patients with underlying haematological malignancies, where broadly accepted classification criteria exist, while diagnostic studies in non‐neutropenic patients are scarce. Importantly, two novel point‐of‐care diagnostic tests, both European conformity (CE) marked for diagnosis of IPA in BALF, have recently become commercially available, but to date have been only validated in patients with underlying haematological malignancies .…”

Section: Introductionmentioning

confidence: 99%

Point‐of‐care diagnosis of invasive aspergillosis in non‐neutropenic patients: Aspergillus Galactomannan Lateral Flow Assay versus Aspergillus‐specific Lateral Flow Device test in bronchoalveolar lavage

Jenks

Mehta

Taplitz

et al. 2019

Mycoses

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Summary Background We compared new Aspergillus Galactomannan Lateral Flow Assay with the newly formatted Aspergillus‐specific Lateral Flow device tests for the diagnosis of invasive pulmonary aspergillosis (IPA) in non‐neutropenic patients. Methods We performed both tests in 82 bronchoalveolar lavage fluid samples from 82 patients at risk for IPA but without underlying haematologic malignancy. Samples were collected between September 2016 and September 2018 at the University of California San Diego, United States. IPA was classified following two published consensus criteria. Results Classification of cases varied widely between the two consensus criteria. When using criteria established for the intensive care unit, 26/82 patients (32%) met criteria for proven or putative IPA. Both point‐of‐care assays showed sensitivities ranging between 58% and 69%, with specificities between 68% and 75%. Sensitivity increased up to 81% when both tests were combined. Conclusion The study outlines the need for updated, unified and more broadly applicable consensus definitions for classifying IPA in non‐neutropenic patients, a work that is currently in progress. Both point‐of‐care tests showed comparable performance, with sensitivities and specificities in the 60%‐70% range when used alone and increasing to 80% when used in combination. The new point‐of‐care tests may serve a role at the bedside in those with clinical suspicion of IPA.

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Diagnosis of invasive aspergillosis in hematological malignancy patients: Performance of cytokines, Asp LFD, and Aspergillus PCR in same day blood and bronchoalveolar lavage samples

Abstract: High serum IL-8 levels were highly specific, and when combined with either the BALF Aspergillus-specific LFD, or BALF Aspergillus PCR also highly sensitive for diagnosis of IA.

Cited by 87 publications

References 39 publications

The early diagnostic value of serum galactomannan antigen test combined with chest computed tomography for invasive pulmonary aspergillosis in pediatric patients after hematopoietic stem cell transplantation

The early diagnostic value of serum galactomannan antigen test combined with chest computed tomography for invasive pulmonary aspergillosis in pediatric patients after hematopoietic stem cell transplantation

False positive bronchoalveolar lavage galactomannan: Effect of host and cut‐off value

Point‐of‐care diagnosis of invasive aspergillosis in non‐neutropenic patients: Aspergillus Galactomannan Lateral Flow Assay versus Aspergillus‐specific Lateral Flow Device test in bronchoalveolar lavage

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