Galactomannan in Bronchoalveolar Lavage Fluid for Diagnosis of Invasive Pulmonary Aspergillosis with Nonneutropenic Patients

Zhuang, Qidong; Ma, Hongying; Zhang, Yun; Chen, Lei; Wang, Li; Zheng, Lin; Deng, Zaichun; Chen, Zhongbo

doi:10.1155/2017/3685261

Cited by 12 publications

(4 citation statements)

References 22 publications

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“…The presence of one or more cavities with fungal ball is almost definitive of CPA; however, fungal ball is seen only in about 40 to 60% of all cases (68% in the current study) (3). The Aspergillus precipitins have poor sensitivity (20 to 25%), while A. fumigatus-specific IgG has a sensitivity of 85 to 92% (98.4% in the current study) (3,9,11). Thus, the diagnosis of CPA relies primarily on the demonstration of A. fumigatus-specific IgG (9).…”

Section: Discussionmentioning

confidence: 61%

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Utility of Serum and Bronchoalveolar Lavage Fluid Galactomannan in Diagnosis of Chronic Pulmonary Aspergillosis

et al. 2019

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The value of serum and bronchoalveolar lavage fluid galactomannan (BALF-GM) in diagnosing chronic pulmonary aspergillosis (CPA) remains unclear. Here, we study the diagnostic efficacy of GM in the diagnosis of CPA. We included consecutive treatment-naive subjects with CPA. For calculating the specificity of serum GM, we enrolled diseased controls (minimally symptomatic subjects previously treated for pulmonary tuberculosis, not meeting the criteria for CPA). To calculate the specificity of BALF-GM, subjects with pulmonary disorders other than CPA who underwent bronchoscopy were included. We determined the cutoff of serum and BALF-GM levels using receiver operating characteristic (ROC) curve analysis. We enrolled 243 consecutive treatment-naive subjects (53.5% males) of CPA with a mean (standard deviation) age of 43.6 (14.7) years. Forty-five (60% males; age, 46.7 [15.7] years) and 27 (59.3% males; age, 52.6 [12.8] years) subjects served as controls for serum and BALF-GM, respectively. The best cutoff value for serum and BALF-GM was 0.55 (area under the ROC curve [AUROC], 0.605; sensitivity, 38%; specificity, 87%) and 1.375 (AUROC, 0.836; sensitivity, 68%; specificity, 93%), respectively. At a cutoff value of 2.5, BALF-GM had a sensitivity and specificity of 50% and 100%, respectively. BALF-GM performs better than serum GM and may be helpful in the diagnosis of CPA in selected patients. More studies are required to confirm our findings.

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Section: Discussionmentioning

confidence: 61%

“…Most evidence on the utility of serum and bronchoalveolar lavage fluid (BALF)-GM estimation comes from subjects with invasive pulmonary aspergillosis (IPA) (1,(10)(11)(12). There are limited data from retrospective studies regarding the utility of serum or BALF-GM in diagnosing CPA (13)(14)(15).…”

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confidence: 99%

Utility of Serum and Bronchoalveolar Lavage Fluid Galactomannan in Diagnosis of Chronic Pulmonary Aspergillosis

et al. 2019

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“…However, recent studies have found that the incidence of IPA is increasing year by year in nonneutropenic patients ( 8 ). The sample sizes of most studies of nonneutropenic IPA ( 9 , 10 ) are small. This article included more nonneutropenic IPA patients and increased the reliability of our conclusion.…”

Section: Discussionmentioning

confidence: 99%

The Clinical Characteristics of Patients With Nonneutropenic Invasive Pulmonary Aspergillosis

Liu

Wang

et al. 2021

Front. Med.

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Objective: The goal of this study was to reveal the clinical manifestations of nonneutropenic invasive pulmonary aspergillosis (IPA), which are different from those of neutropenic patients.Methods: The clinical data of patients with nonneutropenic IPA were collected at the Department of Respiratory and Critical Care Medicine, Jinling Hospital, from February 2009 to November 2019. We analyzed the general conditions, clinical manifestations, imaging findings, and laboratory tests of these IPA patients.Results: A total of 116 patients with nonneutropenic IPA (31 proven and 85 probable) were included. They had an average age of 59.8 years. The most common underlying disease was chronic obstructive pulmonary disease (COPD, n = 33). The common clinical symptoms included cough (93.1%, n = 108), expectoration (59.5%, n = 69), fever (57.8%, n = 67), hemoptysis (30.2%, n = 35), and dyspnea (40.5%, n = 47). The common CT imaging manifestations included consolidation (47.4%, n = 55), cavities (47.4%, n = 55), air crescent sign (14.7%, n = 17), and nodules (8.6%, n = 10). Multiple lesions (74.1%, n = 86) were more common than single lesions (17.2%, n = 20) and diffuse lesions (8.6%, n = 10). The positive rate of laboratory tests was 88.2% (30/34) for BALF galactomannan (GM), 55.4% (56/101) for serum GM, 45.3% (48/106) for 1,3-β-D-glucan (BDG), 43.3% (46/106) for sputum culture, and 36.4% (20/55) for BALF culture. Patients who had high serum GM level [GM optical density index (ODI) >1] were more likely to have severe respiratory symptoms and higher serum ferritin. Further investigation showed that there was a positive correlation between serum GM level and serum ferritin level.Conclusion: The clinical symptoms and radiological manifestations of nonneutropenic IPA are diverse and often lead to delayed diagnosis. It is important to become more vigilant of aspergillosis in nonneutropenic patients in order to achieve early diagnosis and treatment and to reduce mortality.

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“…Compared with data from previous studies (21,22), there is a certain difference between the BALF GM value of patients with chronic airway inflammation and the BALF GM value of patients with various underlying diseases or neutropenia. It is believed that the GM test may need to be based on different underlying diseases or immunity, such as neutropenia and non-neutropenia (23,24), organ transplantation and non-organ transplantation (25,26), and hematological tumors (27,28), but setting different optimal thresholds may require more research to confirm. The best cutoff value of BALF GM in pulmonary Aspergillus patients with different risk factors should be set according to the results of BALF GM tests, further increasing the diagnostic efficacy of BALF GM for pulmonary aspergillosis cooccurring with other conditions.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Value of Galactomannan in Bronchoalveolar Lavage Fluid for Chronic Respiratory Disease with Pulmonary Aspergillosis

Lai

Zeng

et al. 2020

J Clin Microbiol

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The objective of this study was to explore the diagnostic value of the bronchoalveolar lavage fluid galactomannan (BALF GM) test for chronic respiratory disease with pulmonary aspergillosis and to establish the optimal cutoff value. Samples from a total of 309 chronic respiratory disease patients seen at the respiratory medicine department of Peking University Shenzhen Hospital from September 2016 to September 2019 were analyzed. According to the diagnostic criteria, we divided the patients into a case group (n = 79, comprising 25 proven cases and 54 probable cases) and a control group (n = 230). Bronchoalveolar lavage fluid was collected, and the BALF GM test results were analyzed. A nonparametric rank sum test showed that the mean rank of the case group was 255.30, which was higher than that of the control group (120.55). The Z-value was −11.567 (P = 0.000), indicating that the general distributions of BALF GM differed between the two groups. A BALF GM cutoff value of 0.88 showed the highest diagnostic efficacy for pulmonary aspergillosis. The sensitivity, specificity, positive predictive value, and negative predictive value were 77.2%, 93%, 79.2%, and 92.2%, respectively. As the cutoff value increased, the specificity and sensitivity of the BALF GM test increased and decreased, respectively. The BALF GM test can be used confirm the diagnosis of patients with pulmonary aspergillosis and chronic respiratory disease. The optimum BALF GM cutoff value is 0.88.

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Galactomannan in Bronchoalveolar Lavage Fluid for Diagnosis of Invasive Pulmonary Aspergillosis with Nonneutropenic Patients

Cited by 12 publications

References 22 publications

Utility of Serum and Bronchoalveolar Lavage Fluid Galactomannan in Diagnosis of Chronic Pulmonary Aspergillosis

Utility of Serum and Bronchoalveolar Lavage Fluid Galactomannan in Diagnosis of Chronic Pulmonary Aspergillosis

The Clinical Characteristics of Patients With Nonneutropenic Invasive Pulmonary Aspergillosis

Diagnostic Value of Galactomannan in Bronchoalveolar Lavage Fluid for Chronic Respiratory Disease with Pulmonary Aspergillosis

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