Open AccessA positive BAL galactomannan in non-haemato-oncology patients risks harmful overtreatment
Author(s) -
Anthony W. Martinelli,
Parth Patil,
Vanessa Wong,
David Enoch,
Clare R. Sander
Publication year - 2019
Publication title -
journal of medical microbiology/journal of medical microbiology
Language(s) - Uncategorized
Resource type - Journals
SCImago Journal Rank - 0.91
H-Index - 117
eISSN - 1473-5644
pISSN - 0022-2615
DOI - 10.1099/jmm.0.001109
Subject(s) - galactomannan , medicine , voriconazole , aspergillosis , bronchoalveolar lavage , malignancy , hematology , gastroenterology , intensive care medicine , immunology , antifungal , dermatology , lung
. Evidence for the clinical utility of bronchoalveolar lavage (BAL) galactomannan in the management of fungal disease outside of haemato-oncology patients is limited. Aim . To determine how the introduction of BAL galactomannan testing impacted on the diagnosis and management of invasive aspergillosis and other fungal diseases in non-haemato-oncology patients. Methodology . Retrospective review of all adult patients (age ≥16 years) without a diagnosis of haematological malignancy who had a positive BAL galactomannan from 1 November 2014 to 30 April 2018. Using electronic patient records we obtained demographic data, clinical details, laboratory investigations, relevant radiology and antimicrobial history for each case. Results . In total, 121 episodes with a galactomannan OD index of ≥0.500 were included in the study; 29 cases (24 %) were felt to reflect fungal disease. Antifungal therapy was commenced as a direct consequence of a positive BAL galactomannan result in 13 patients where the ultimate diagnosis was subsequently considered to be non-mycological: associated medication-related side-effects in this group included deranged liver function tests ( n =3), rash ( n =1) and fever ( n =1), related to amphotericin B ( n =1) and voriconazole ( n =4). Conclusion . We show that vigilance is required when interpreting galactomannan results in non-haematology patients to avoid potentially harmful overtreatment.