We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
Diagnosing pulmonary aspergillosis in patients with hematological malignancies: a multicenter prospective evaluation of an Aspergillus PCR assay and a galactomannan ELISA in bronchoalveolar lavage samples.
- Authors
Reinwald, Mark; Spiess, Birgit; Heinz, Werner J.; Vehreschild, Jörg J.; Lass-Flörl, Cornelia; Kiehl, Michael; Schultheis, Beate; Krause, Stefan W.; Wolf, Hans-Heinrich; Bertz, Hartmut; Maschmeyer, Georg; Hofmann, Wolf-Karsten; Buchheidt, Dieter
- Abstract
Objectives Diagnosing invasive pulmonary aspergillosis ( IPA) remains a challenge in patients with hematological malignancies. The clinical significance of testing bronchoalveolar lavage ( BAL) samples both with polymerase chain reaction ( PCR) and Aspergillus galactomannan ELISA ( GM) is unclear, and the BAL cutoff for GM has not been clearly evaluated yet. Methods Using a validated nested PCR assay and a GM ELISA, we prospectively examined BAL samples from 87 hematological patients at high risk of IPA. Of 76 (87%) evaluable patients, 29 patients had proven or probable disease. Results The receiver operating characteristic ( ROC) analysis of GM optical density ( OD) cutoff levels yielded a BAL OD of 0.5 to be optimal. We identified 29 probable or proven cases based on this OD. Sensitivity and specificity for BAL GM were 0.79 (95% CI, 0.62-0.9) and 0.96 (95% CI, 0.86-0.99), respectively. For BAL PCR, sensitivity and specificity were 0.59 (95% CI, 0.41-0.75) and 0.87 (95% CI, 0.75-0.94), respectively. Combining BAL GM and PCR for diagnosis showed a sensitivity and specificity rate of 0.55 (95% CI, 0.38-0.72) and 1.0 (95% CI, 0.93-1.0), respectively, if positivity was defined by positive results for both tests. If either positive BAL GM or positive BAL PCR results defined test positivity, the sensitivity was 0.83 (95% CI, 0.65-0.92), and the specificity was 0.83 (95% CI, 0.70-0.91) Conclusions In terms of optimal sensitivity and specificity, a GM OD cutoff of 0.5 was determined for BAL samples. Positivity for both GM and Aspergillus PCR in BAL makes a pulmonary aspergillosis highly likely.
- Subjects
PULMONARY aspergillosis; BRONCHOALVEOLAR lavage; POLYMERASE chain reaction; OPACITY (Optics); ENZYME-linked immunosorbent assay; DNA polymerases; LUNG disease diagnosis
- Publication
European Journal of Haematology, 2012, Vol 89, Issue 2, p120
- ISSN
0902-4441
- Publication type
Article
- DOI
10.1111/j.1600-0609.2012.01806.x