Infectious pulmonary complications after stem cell transplantation or chemotherapy: Diagnostic yield of bronchoalveolar lavage

Bissinger, Alfred Lennart; Einsele, Hermann; Hamprecht, Klaus; Schumacher, U; Kandolf, Reinhard; Loeffler, Juergen; Aepinus, Christian; Bock, C.‐Thomas; Jahn, Gerhard; Hebart, Holger

doi:10.1016/j.diagmicrobio.2005.03.005

Cited by 32 publications

(28 citation statements)

References 42 publications

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“…A probable explanation for detection of HSV in bronchoalveolar lavage fluid is oral contamination following mucosal reactivation. This study confirmed the frequent detection of HSV DNA in bronchoalveolar lavage fluid specimens (19%) obtained from a largely immunocompromised population [Cook et al, 1998;Malcolm et al, 2001;Bruynseels et al, 2003;Garbino et al, 2004;Bissinger et al, 2005;Neurohr et al, 2005]. In addition, evidence has been obtained that the quantity of HSV DNA detected in the bronchoalveolar lavage fluid correlated with the severity of outcome.…”

Section: Discussionsupporting

confidence: 85%

Quantitative detection of herpes simplex virus DNA in the lower respiratory tract

Gooskens

Templeton

Claas

et al. 2007

Journal of Medical Virology

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Quantitation of herpes simplex virus (HSV) DNA in bronchoalveolar lavage specimens could indicate an infectious role in the lower respiratory tract. The aim of this study was to compare quantitative HSV DNA results from adult bronchoalveolar lavage specimens to clinical outcome. Quantitative real-time PCR assays targeting HSV and other herpes viruses were performed on adult bronchoalveolar lavage specimens obtained from a largely immunocompromised population during a 1-year period. The results were compared to patient characteristics and outcome. HSV DNA was detected in 11 (19%) of 57 bronchoalveolar lavage specimens with a mean viral level of 5.6 log genome equivalents/ml (range, 2.9-8.1 log). A threshold of HSV DNA levels equal or higher than 5.0 log (n = 7) was associated with mortality within 28 days following hospital admission (odds ratio [OR], 6.8; 95% confidence interval [CI], 1.2-39.2). A threshold level of 5.5 log was associated with mortality within 28 days of sampling (OR 8.5; 95% CI 1.2-62.1), only after excluding patients receiving specific antiviral medication. Patients with HSV DNA levels equal or higher than 7.5 log had severe respiratory failure. Viral pneumonia was histologically proven in one patient with 8.0 log at autopsy. No patient with HSV DNA levels below 5.5 log (n = 5) or DNA levels higher than 5.0 log of cytomegalovirus (CMV) (n = 3), Epstein-Barr virus (EBV) (n = 9), varicella-zoster virus (VZV) (n = 1), or human herpesvirus 6 (HHV-6) (n = 0) died within 28 days of hospital admission. We conclude that quantitative detection of HSV DNA in bronchoalveolar lavage fluid is a potential diagnostic tool for detection of relevant viral infection of the lower respiratory tract.

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Section: Discussionsupporting

confidence: 85%

Quantitative detection of herpes simplex virus DNA in the lower respiratory tract

Gooskens

Templeton

Claas

et al. 2007

Journal of Medical Virology

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“…As long ago as 1998, we demonstrated that colonization of the lower respiratory tract with A. fumigatus prior to allogeneic stem cell transplantation (as detected by PCR) was significantly associated with the development of invasive pulmonary aspergillosis after transplantation [12]. In a follow-up study, the use of PCR increased the diagnostic yield from 56% to 73% for fungal infections in BAL samples, compared with classic methods [13]. PCR assays from cerebrospinal fluid may have potential for early detection of A. fumigatus in patients with cerebral aspergillosis.…”

Section: Specimen Selectionmentioning

confidence: 92%

Diagnostic Utility of DNA from Aspergillus in Whole Blood Specimens

Löffler

Kurzai

2011

Curr Fungal Infect Rep

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For several years, PCR-based detection of Aspergillus DNA has been considered a promising tool for the diagnosis of invasive aspergillosis, but its broader implementation has been hampered by a lack of standardization and the uncertain diagnostic accuracy of the wide variety of published protocols. Recently, new attempts have been made to address this problem and define a quality standard for diagnostic Aspergillus PCR. This review summarizes technical aspects of up-to-date protocols, focusing on the recently proposed guidelines of the European Aspergillus PCR Initiative (EAPCRI) for whole blood PCR testing.

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“…The species-specific approach using a nested PCR has been studied in BAL [78,79]. The additional use of PCR detection methods increased the diagnostic yield from 56 to 73%, especially concerning viral and fungal infections in BAL samples [80]. A positive Aspergillus PCR in BAL fluid has estimated sensitivity of 67-100% and specificity of 68-100% for IPA [46,[80][81][82][83][84][85][86][87][88][89][90][91].…”

Section: Pcr Assaysmentioning

confidence: 99%

Diagnosing Aspergillosis: The Role of Invasive Diagnostic Interventions

Lass‐Flörl

Freund

2009

Aspergillosis: From Diagnosis to Prevention

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The diagnosis of invasive aspergillosis remains challenging and current conventional methods are limited for the diagnosis of invasive fungal infections. The gold-standard for the definite diagnosis of proven invasive pulmonary aspergillosis remains either histopathologic, cytopathologic or direct tissue examination, based on the documentation of typical hyphae and a positive culture of Aspergillus spp. This chapter reviews the yield of invasive procedures in the diagnosis of aspergillosis. Biopsies may be taken percutaneously, bronchoscopically, via open surgery or video-assisted thorascopic surgery. Computed tomography-guided percutaneous, bronchoscopic and open lung biopsies have been performed with a diagnostic yield of 80-100, 51 and 70%, respectively. Bronchoscopy with bronchoalveolar lavage is generally helpful in diagnosing invasive pulmonary aspergillosis, especially in immunocompromised patients with diffuse lung involvement. The sensitivity and specificity of a positive result of bronchoalveolar lavage fluid are ∼50 and 97%, respectively. All specimens obtained via invasive interventions including bronchoalveolar lavage should be processed for microscopy and cytology, fungal cultures and by means of any other available procedure (e.g., Aspergillus PCR and galactomannan). Combining microscopy and culture will increase the diagnostic yield by 15-20%. Combining culture, microscopy, serology, and Aspergillus PCR in lung tissues and/or bronchial samples will increase the diagnostic yield by 99%.

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Infectious pulmonary complications after stem cell transplantation or chemotherapy: Diagnostic yield of bronchoalveolar lavage

Cited by 32 publications

References 42 publications

Quantitative detection of herpes simplex virus DNA in the lower respiratory tract

Quantitative detection of herpes simplex virus DNA in the lower respiratory tract

Diagnostic Utility of DNA from Aspergillus in Whole Blood Specimens

Diagnosing Aspergillosis: The Role of Invasive Diagnostic Interventions

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