Performance of Galactomannan, Beta-
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            -Glucan, Aspergillus Lateral-Flow Device, Conventional Culture, and PCR Tests with Bronchoalveolar Lavage Fluid for Diagnosis of Invasive Pulmonary Aspergillosis

Hoenigl, Martin; Prattes, Juergen; Spieß, Birgit; Wagner, Jasmin; Prueller, Florian; Raggam, Reinhard B.; Posch, Verena; Duettmann, Wiebke; Hoenigl, K.; Wölfler, Albert; Koidl, Christoph; Buzina, Walter; Reinwald, Mark; Thornton, Christopher R.; Krause, Robert; Buchheidt, Dieter

doi:10.1128/jcm.00467-14

Cited by 205 publications

(210 citation statements)

References 53 publications

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“…Some physicians tend to avoid or delay bronchoscopy because of the risk of bleeding in the setting of thrombocytopenia or because they consider the invasive procedure to be too strenuous for patients with wasting diseases. Our findings as well as data of other studies 26 support the concept of obtaining specimens from the direct site of infection, for example, BALF, and outweigh the risks of the procedure itself with the significant diagnostic gain. The combination of PCR and GM in BALF resulted in a further increase of combined sensitivity (with a DOR of 29.2) with specificity remaining >90%.…”

Section: Discussionsupporting

confidence: 75%

“…34 The present study expands this concept by adding a simultaneous molecular detection tool, that is, Aspergillus-specific PCR. There are other studies of diagnostic performance of GM, PCR, and the benefit of test combination 26,35 with the trend that performance of both tests is generally better in samples from the site of infection, that is, BALF, than in blood. Nevertheless, results vary widely and are hardly comparable among each other.…”

Section: Discussionmentioning

confidence: 99%

“…[15][16][17] Furthermore, sensitivity of serum GM may decrease significantly in case of administration of antifungal prophylaxis or empirical/pre-emptive therapy. 18,19 Aspergillus PCR has been shown to be a very promising method for detection of fungal infection by using BALF or blood from immunocompromised patients, [20][21][22][23][24] especially when combined with the GM test 25,26 and performed early in the course of the infection. 22 While both GM and Aspergillus PCR have become increasingly important for diagnosis of IA in recent years it remains unclear whether or not these tests need to be performed with BALF (i.e., primary site of infection) or testing of single blood samples is sufficient to achieve acceptable sensitivity.…”

Section: Introductionmentioning

confidence: 99%

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Galactomannan testing andAspergillusPCR in same-day bronchoalveolar lavage and blood samples for diagnosis of invasive aspergillosis

et al. 2016

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In recent years galactomannan antigen testing (GM) and also Aspergillus PCR have become increasingly important for diagnosis of invasive aspergillosis (IA). Whether or not these tests need to be performed with bronchoalveolar lavage fluid (BALF; i.e., primary site of infection), or testing of blood samples is sufficient, remains, however, a matter of debate. We evaluated the diagnostic performance of GM ELISA, and Aspergillus PCR by using BALF samples and blood samples obtained at the same day from a total of 53 immunocompromised patients (16 with probable/proven IA and 37 with no evidence of IA according to the revised EORTC/MSG criteria; 38 patients with hematological malignancies were prospectively enrolled at the Medical University of Graz, Austria, 15 patients with mixed underlying diseases at the Mannheim University Hospital). Patients with possible IA were excluded from this analysis. A total of 34/53 (64%) of all patients and 12/16 (75%) of patients with probable/proven IA received mold-active antifungal prophylaxis/therapy at the time of the BALF procedure. Sensitivities of GM and Aspergillus PCR were 38% and 44% in BALF, and 31% and 0% in blood, respectively. Best sensitivity (75%) for detecting proven/probable IA was achieved when BALF Aspergillus PCR, BALF Eigl et al. 529GM (>1.0 ODI), BALF-culture and serum-GM (>0.5 ODI) were combined (specificity 95%).In conclusion, sensitivities of the evaluated diagnostic tests-when interpreted on their own-were low in BALF and even lower in blood, sensitivities increased markedly when diagnostic tests were combined.

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Section: Discussionsupporting

confidence: 75%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Galactomannan testing andAspergillusPCR in same-day bronchoalveolar lavage and blood samples for diagnosis of invasive aspergillosis

et al. 2016

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“…The LFD is easily performed using native BALF and yields results in 15 minutes. In recent studies, the high potential of this new assay in BAL IPA detection was shown in hematological malignancy and solid-organ transplant (SOT) patients (26)(27)(28)(29)(30)(31). However, no data on the performance of the LFD test in nonneutropenic patients with underlying respiratory diseases have been published to date.…”

mentioning

confidence: 99%

Novel Tests for Diagnosis of Invasive Aspergillosis in Patients with Underlying Respiratory Diseases

Prattes

Flick²,

Prüller

et al. 2014

Am J Respir Crit Care Med

117

114

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Rationale: Invasive pulmonary aspergillosis has been increasingly reported in nonneutropenic patients, including those with underlying respiratory diseases.Objectives: We compared the diagnostic performances of galactomannan, 1,3-b-D-glucan, and Aspergillus-specific lateralflow device tests with that of conventional culture by using bronchoalveolar lavage fluid samples from patients with underlying respiratory diseases.Methods: We analyzed 268 bronchoalveolar lavage samples from 221 patients with underlying respiratory diseases (and without hematologic malignancy or previous solid organ transplantation) that were collected for routine microbiological workup between February 2012 and May 2014 at the University Hospital of Graz, Austria. Invasive pulmonary aspergillosis was defined according to European Organization of Research and Treatment of Cancer/ Mycoses Study Group criteria modified for patients with respiratory diseases.Measurements and Main Results: Thirty-one patients (14%) had probable or proven, 25 possible, and the remaining 165 patients no invasive pulmonary aspergillosis. Probable/proven aspergillosis was associated with a significantly higher (P = 0.034) 30-day mortality rate of 32%. Sensitivities, specificities, and diagnostic odd ratios differed markedly between galactomannan (cut-off 0. Conclusions: Probable or proven invasive pulmonary aspergillosis was diagnosed in 14% of our study population and associated with significantly higher 30-day mortality rates. Although the performance of b-D-glucan was limited by low specificity and that of mycological culture by low sensitivity, the Aspergillus lateral-flow device seems to be a promising alternative to galactomannan testing, which remains the diagnostic gold standard for aspergillosis. Clinical trial registered with www.clinicaltrials.gov (NCT 02058316).

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“…1. A total of seven studies were included in our analysis (Held et al, 2013;Hoenigl et al, 2012Hoenigl et al, , 2014Prattes et al, 2014;Thornton, 2008;White et al, 2013;Willinger et al, 2014). The characteristics of the studies are shown in Table 1.…”

Section: Overall Analysismentioning

confidence: 99%

Diagnostic accuracy of a novel lateral-flow device in invasive aspergillosis: a meta-analysis

Pan

Zhang

et al. 2015

Journal of Medical Microbiology

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A novel lateral-flow device (LFD) has been invented for use as a diagnostic tool for invasive aspergillosis (IA). We conducted a meta-analysis to assess the diagnostic accuracy of the device. Published studies that used the European Organization for Research and Treatment of Cancer/Mycoses Study Group criteria and provided sufficient data were included. Two reviewers independently collected the data from each study and assessed the risk bias using the Quality Assessment of Diagnostic Accuracy Studies-2. The pooled sensitivity, specificity and diagnostic odds ratio (DOR) were computed and reported with a 95 % confidence interval 90 (95 % CI,) in the LFD test using serum. We concluded that the Aspergillus LFD had a good diagnostic value in immunocompromised patients at risk of IA. The BAL LFD might have a better performance than the serum LFD test.

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Performance of Galactomannan, Beta- d -Glucan, Aspergillus Lateral-Flow Device, Conventional Culture, and PCR Tests with Bronchoalveolar Lavage Fluid for Diagnosis of Invasive Pulmonary Aspergillosis

Cited by 205 publications

References 53 publications

Galactomannan testing andAspergillusPCR in same-day bronchoalveolar lavage and blood samples for diagnosis of invasive aspergillosis

Galactomannan testing andAspergillusPCR in same-day bronchoalveolar lavage and blood samples for diagnosis of invasive aspergillosis

Novel Tests for Diagnosis of Invasive Aspergillosis in Patients with Underlying Respiratory Diseases

Diagnostic accuracy of a novel lateral-flow device in invasive aspergillosis: a meta-analysis

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