Utility of bronchoalveolar lavage fluid galactomannan alone or in combination with PCR for the diagnosis of invasive aspergillosis in adult hematology patients: A systematic review and meta-analysis

Heng, Siow Chin; Morrissey, Orla; Chen, Sharon C.‐A.; Thursky, Karin; Manser, Renée; Nation, Roger L.; Kong, David Chee Ming; Slavin, Monica A

doi:10.3109/1040841x.2013.804033

Cited by 101 publications

(86 citation statements)

References 70 publications

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“…This information may have clinical utility in cases such as the one described here, but it is worth underscoring that antigen cross-reactivity, even if wide, does not necessarily confer poor test specificity. Illustratively, a positive BAL galactomannan level has shown good specificity for invasive Aspergillosis when applied to a high pre-test probability transplant population [10]. It is also important to note that our patient received piperacillin-tazobactam, an antibiotic to which false-positive galactomannan test results have been attributed.…”

Section: Discussionmentioning

confidence: 72%

Penicillium citrinum : Opportunistic pathogen or idle bystander? A case analysis with demonstration of galactomannan cross-reactivity

Hesse

Luethy

Beigel

et al. 2017

Medical Mycology Case Reports

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We present a case of an immunocompromised woman with fever, pulmonary infiltrates and multiple bronchoalveolar lavage (BAL) cultures positive for Penicillium citrinum with a concomitant high BAL galactomannan level. We report the results of Aspergillus galactomannan testing performed on culture supernatants from her P. citrinum strain that confirmed the suspected cross-reactivity. Finally, we discuss the clinical significance and antifungal susceptibility of P. citrinum in our case and review the literature.

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Section: Discussionmentioning

confidence: 72%

Penicillium citrinum : Opportunistic pathogen or idle bystander? A case analysis with demonstration of galactomannan cross-reactivity

Hesse

Luethy

Beigel

et al. 2017

Medical Mycology Case Reports

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“…Bronchoalveolar lavage galactomannan appears to be more sensitive and specific in patients with HM and HSCT (92% sensitive, 98% specific), compared to SOT recipients (30%‐100% sensitive, 87%‐94% specific) or mixed patient populations (85% sensitive, 95% specific) . A wide range of PPVs have been reported at various cut‐offs, although PPVs are still highest among patients with HM, with values generally ranging from 70% to 100%, with one outlier study at 50% .…”

Section: Discussionmentioning

confidence: 99%

“…BAL‐GM seems to have higher positive predictive value (PPV) for IA in neutropenic patients with HM, as compared to other hosts at risk for IA . Differences in patient populations, methodologies and optical density (OD) cut‐offs have yielded heterogeneous results . This study was designed to evaluate the positive predictive performance of BAL‐GM in a contemporary cohort, across different patient groups.…”

Section: Introductionmentioning

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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“…BAL is more sensitive than serum samples; however, the cut-off value for BAL samples has not been clarified. In a meta-analysis a cut-off value of >1.5 has been suggested [53]. Serum galactomannan antigen testing should be repeated twice weekly during neutropenia.…”

Section: Fungal Infectionsmentioning

confidence: 99%

An overview of infectious complications after allogeneic hematopoietic stem cell transplantation

Şahin

Toprak

Atilla

et al. 2016

Journal of Infection and Chemotherapy

185

163

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Infections are the most common and significant cause of mortality and morbidity after allogeneic hematopoietic stem cell transplantation (allo-HSCT). The presence of neutropenia and mucosal damage are the leading risk factors in the early pre-engraftment phase. In the early post-engraftment phase, graft versus host disease (GvHD) induced infection risk is increased in addition to catheter related infections. In the late phase, in which reconstitution of cellular and humoral immunity continues, as well as the pathogens seen during the early post-engraftment phase, varicella-zoster virus and encapsulated bacterial infections due to impaired opsonization are observed. An appropriate vaccination schedule following the cessation of immunosuppressive treatment after transplantation, intravenous immunoglobulin administration, and antimicrobial prophylaxis with penicillin or macrolide antibiotics during immunosuppressive treatment for GvHD might decrease the risk of bacterial infections. Older age, severe mucositis due to toxicity of chemotherapy, gastrointestinal tract colonization, prolonged neutropenia, unrelated donor and cord blood originated transplantations, acute and chronic GvHD are among the most indicative clinical risk factors for invasive fungal infections. Mold-active anti-fungal prophylaxis is suggested regardless of the period of transplantation among high risk patients. The novel serological methods, including Aspergillus galactomannan antigen and beta-D-glucan detection and computed tomography are useful in surveillance. Infections due to adenovirus, influenza and respiratory syncytial virus are encountered in all phases after allo-HSCT, including pre-engraftment, early post-engraftment and late phases. Infections due to herpes simplex virus-1 and -2 are mostly seen during the pre-engraftment phase, whereas, infections due to cytomegalovirus and human herpes virus-6 are seen in the early post-engraftment phase and Epstein-Barr virus and varicella-zoster virus infections often after +100th day. In order to prevent mortality and morbidity of infections after allo-HSCT, the recipients should be carefully followed-up with appropriate prophylactic measures in the post-transplant period.

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Utility of bronchoalveolar lavage fluid galactomannan alone or in combination with PCR for the diagnosis of invasive aspergillosis in adult hematology patients: A systematic review and meta-analysis

Cited by 101 publications

References 70 publications

Penicillium citrinum : Opportunistic pathogen or idle bystander? A case analysis with demonstration of galactomannan cross-reactivity

Penicillium citrinum : Opportunistic pathogen or idle bystander? A case analysis with demonstration of galactomannan cross-reactivity

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

An overview of infectious complications after allogeneic hematopoietic stem cell transplantation

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