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- Title
Comparison of an Aspergillus Real-time Polymerase Chain Reaction Assay with Galactomannan Testing of Bronchoalvelolar Lavage Fluid for the Diagnosis of Invasive Pulmonary Aspergillosis in Lung Transplant Recipients.
- Authors
Luong, Me-Linh; Clancy, Cornelius J.; Vadnerkar, Aniket; Kwak, Eun Jeong; Silveira, Fernanda P.; Wissel, Mark C.; Grantham, Kevin J.; Shields, Ryan K.; Crespo, Maria; Pilewski, Joseph; Toyoda, Yoshiya; Kleiboeker, Steven B.; Pakstis, Diana; Reddy, Sushruth K.; Walsh, Thomas J.; Nguyen, M. Hong
- Abstract
Aspergillus PCR and galactomannan testing of bronchoalveolar lavage fluid have excellent diagnostic performance for pulmonary aspergillosis in lung transplant recipients. Both tests offer the potential advantage over culture-based methods of rapid turn-around, which may facilitate timely initiation of antifungal therapy.Background. Early diagnosis and treatment of invasive pulmonary aspergillosis (IPA) improves outcome.Methods. We compared the performance of publicly available pan-Aspergillus, Aspergillus fumigatus–, and Aspergillus terreus–specific real-time polymerase chain reaction (PCR) assays with the Platelia galactomannan (GM) assay in 150 bronchoalveolar lavage (BAL) samples from lung transplant recipients (16 proven/probable IPA, 26 Aspergillus colonization, 11 non-Aspergillus mold colonization, and 97 negative controls).Results. The sensitivity and specificity of pan-Aspergillus PCR (optimal quantification cycle [Cq], ≤35.0 by receiver operating characteristic analysis) and GM (≥.5) for diagnosing IPA were 100% (95% confidence interval, 79%–100%) and 88% (79%–92%), and 93% (68%–100%) and 89% (82%–93%), respectively. The sensitivity and specificity of A. fumigatus–specific PCR were 85% (55%–89%) and 96% (91%–98%), respectively. A. terreus–specific PCR was positive for the 1 patient with IPA due to this species; specificity was 99% (148 of 149 samples). Aspergillus PCR identified 1 patient with IPA not diagnosed by GM. For BAL samples associated with Aspergillus colonization, the specificity of GM (92%) was higher than that of pan-Aspergillus PCR (50%; P = .003). Among negative control samples, the specificity of pan-Aspergillus PCR (97%) was higher than that of BAL GM (88%; P = .03). Positive results for both BAL PCR and GM testing improved the specificity to 97% with minimal detriment to sensitivity (93%).Conclusions. A recently developed pan-Aspergillus PCR assay and GM testing of BAL fluid may facilitate the diagnosis of IPA after lung transplantation. A. fumigatus– and A. terreus–specific real-time PCR assays may be useful in rapidly identifying the most common cause of IPA and a species that is intrinsically resistant to amphotericin B, respectively.
- Subjects
COMPARATIVE studies; ASPERGILLUS; POLYMERASE chain reaction; GALACTOMANNANS; PULMONARY aspergillosis; LUNG transplantation
- Publication
Clinical Infectious Diseases, 2011, Vol 52, Issue 10, p1218
- ISSN
1058-4838
- Publication type
Article
- DOI
10.1093/cid/cir185