Diagnostic Value of Galactomannan Antigen Test in Serum and Bronchoalveolar Lavage Fluid Samples from Patients with Nonneutropenic Invasive Pulmonary Aspergillosis

Abstract

The objective of this study was to compare the diagnostic value of galactomannan (GM) detection in bronchoalveolar lavage fluid (BALF) and serum samples from nonneutropenic patients with invasive pulmonary aspergillosis (IPA) and determine the optimal BALF GM cutoff value for pulmonary aspergillosis. GM detection in BALF and serum samples was performed by enzyme-linked immunosorbent assay (ELISA) in 128 patients with clinically suspected nonneutropenic pulmonary aspergillosis between June 2014 and June 2016. On the basis of the clinical and pathological diagnoses, 8 patients were excluded because their diagnosis was uncertain. The remaining 120 patients were diagnosed with either IPA (n ϭ 37), community-acquired pneumonia (CAP; n ϭ 59), noninfectious diseases (n ϭ 19), or tuberculosis (n ϭ 5). At a cutoff optical density index (ODI) value of Ն0.5, the sensitivity of BALF GM detection was much higher than that of serum GM detection (75.68% versus 37.84%; P ϭ 0.001), but there was no significant difference between their specificities (80.72% versus 87.14%; P ϭ 0.286). At a cutoff value of Ն1.0, the sensitivity of BALF GM detection was still much higher than that of serum GM detection (64.86% versus 24.32%; P Ͻ 0.001), and their specificities were similar (90.36% versus 95.71%; P ϭ 0.202). Receiver operating characteristic (ROC) curve analysis showed that when the BALF GM detection cutoff value was 0.7, its diagnostic value for pulmonary aspergillosis was optimized, and the sensitivity and specificity reached 72.97% and 89.16%, respectively. BALF GM detection was valuable for the diagnosis of IPA in nonneutropenic patients, and its diagnostic value was superior to that of serum GM detection. The optimal BALF GM cutoff value was 0.7.KEYWORDS invasive pulmonary aspergillosis, bronchoalveolar lavage fluid, galactomannan antigen, nonneutropenic patients I nvasive pulmonary aspergillosis (IPA) is mainly caused by Aspergillus fumigatus. Aspergillus species can invade the tracheal bronchus and lung directly, resulting in airway colonization, lung inflammatory granuloma, and even more serious sequelae, such as necrotizing pneumonia, and they can also affect other organs through hematogenous spread. Previously, IPA was recognized as occurring mainly in patients with neutrophil deficiencies. Such patients generally have serious immunosuppressive conditions, such as malignant hematopathy, solid organ or hematopoietic stem cell transplants, and human immunodeficiency virus (HIV) infection, or are receiving longterm immunosuppressive therapy (1-3). However, it has increasingly been found that

Galactomannan detection in bronchoalveolar lavage fluids: A diagnostic approach for fungus ball in patients with pulmonary tuberculosis?

“…In general, BAL GM index ≥ 1.0 showed a higher specificity for both fungus ball and aspergilloma detection but a decreased sensitivity compared to BAL GM index ≥ 0.5. Recently, the cut‐off value for BAL GM detection by ROC curve analysis was reported a range of 0.5‐1.18 in non‐neutropenic patients with pulmonary aspergillosis including aspergilloma 7,24 . In this present study, the statistical analysis of the sensitivity, specificity, PPV, NPV, correlation coefficient, likelihood ratios and AUC for GM detection (index ≥ 0.5) in BAL samples from old PTB patients with fungus ball also showed a significant correlation.…”

Pentraxin 3 in bronchoalveolar lavage fluid and plasma in non-neutropenic patients with pulmonary aspergillosis

“…The updated Infectious Diseases Society of America (IDSA) guidelines recommend bronchoalveolar lavage fluid (BALF) galactomannan (GM) and aspergillus IgG antibody testing for diagnosing chronic forms of pulmonary aspergillosis. Our previous work has confirmed that the BALF galactomannan (GM) testing offers diagnostic value [5]. However, invasiveness, numerous false positives, and the lack of standardization suggest that better biomarkers for diagnosing aspergillosis are needed, especially for the early diagnosis of invasive pulmonary aspergillosis (IPA) and subacute invasive aspergillosis (SAIA) in non-neutropenic patients.…”

Cell wall polysaccharides from pathogenic fungi for diagnosis of fungal infectious disease

“…In a more recent systematic review, Zou et al 21 revealed that at an optimal cut‐off index of 1.0, BALF GM test has a higher pooled sensitivity than PCR and serum GM tests, indicating that BALF GM test could be a useful adjunct in the diagnosis of proven and probable IA. Moreover, BALF GM test is valuable for earlier diagnosis of invasive pulmonary aspergillosis (IPA) in non‐neutropenia patients 22 . However, false‐positive results of BALF GM test may occur in lung transplant patients and in those only colonised with Aspergillus 19 .…”