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Performance of lateral flow device and galactomannan for the detection of Aspergillus species in bronchoalveolar fluid of patients at risk for invasive pulmonary aspergillosis
Author(s) -
Miceli Marisa H.,
Goggins Michael I.,
Chander Pranay,
Sekaran Archana K.,
Kizy Anne E.,
Samuel Linoj,
Jiang Hui,
Thornton Christopher R.,
Ramesh Mayur,
Alangaden George
Publication year - 2015
Publication title -
mycoses
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.13
H-Index - 69
eISSN - 1439-0507
pISSN - 0933-7407
DOI - 10.1111/myc.12327
Subject(s) - galactomannan , bronchoalveolar lavage , aspergillosis , medicine , bronchoscopy , gastroenterology , aspergillus , malignancy , lung , surgery , immunology , biology , microbiology and biotechnology
Summary Early diagnosis of invasive pulmonary aspergillosis ( IPA ) remains difficult due to the variable performance of the tests used. We compared the performance characteristics of Aspergillus lateral flow device ( LFD ) in bronchoalveolar lavage ( BAL ) vs. BAL ‐galactomannan ( GM ), for the diagnosis of IPA . 311 BAL specimens were prospectively collected from patients who underwent bronchoscopy from January to May 2013. Patients at risk for IPA were divided into haematological malignancy ( HEM ) and non‐ HEM groups: solid organ transplants ( SOT ) (lung transplant ( LT ) and non‐ LT SOT ); chronic steroid use ( CSU ); solid tumour ( STU ) and others. We identified 96 patients at risk for IPA ; 89 patients (93%) were in the non‐ HEM groups: SOT 57 ( LT , 46, non‐ LT SOT , 11); CSU 21; STU 6, other 5. Only three patients met criteria for IA (two probable; one possible). Overall sensitivity ( SS ) was 66% for both and specificity ( SP ) was 94% vs. 52% for LFD and GM respectively. LFD and GM performance was similar in the HEM group ( SS 100% for both and SP 83% vs. 100% respectively). LFD performance was better than GM among non‐ HEM SOT patients (P = 0.02). Most false‐positive GM results occurred in the SOT group (50.8%), especially among LT patients (56.5%). LFD performance was superior with an overall SP of 95.6% in SOT ( P < 0.002) and 97% in LT patients ( P = 0.0008). LFD is a rapid and simple test that can be performed on BAL to rule out IPA .