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Testing the performance of a prototype lateral flow device using bronchoalveolar lavage fluid for the diagnosis of invasive pulmonary aspergillosis in high‐risk patients
Author(s) -
Castillo Caroline G.,
Kauffman Carol A.,
Zhai Jingyi,
Jiang Hui,
Agozino Stephanie M.,
Miceli Marisa H.
Publication year - 2018
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.12694
Subject(s) - bronchoalveolar lavage , galactomannan , immunoassay , aspergillosis , medicine , aspergillus , pulmonary aspergillosis , aspergillus fumigatus , positive predicative value , predictive value , immunology , antibody , lung , microbiology and biotechnology , biology
Summary The diagnosis of invasive pulmonary aspergillosis ( IPA ) increasingly relies on non‐culture‐based biomarkers in bronchoalveolar lavage ( BAL ) fluid. The Aspergillus lateral flow device ( LFD ) is a rapid immunoassay that uses a novel Aspergillus monoclonal antibody to gain specificity. The objective of the study is to compare specificity and sensitivity of the prototype LFD and the galactomannan ( GM ) enzyme immunoassay in BAL fluid in high‐risk patients. A total of 114 BAL samples from 106 patients at high risk for IPA were studied: 8 patients had proven/probable IPA , 16 had possible IPA and 82 did not have IPA . In patients with proven/probable IPA , specificity of LFD was 94% and GM was 89%; sensitivity of LFD was 38% and GM was 75%. Negative predictive value ( NPV ) for LFD was 94% and for GM was 98%; positive predictive value ( PPV ) was 38% for both tests. The use of anti‐mould prophylaxis did not affect specificity but resulted in decreased NPV of both LFD and GM . Union and intersection analysis showed no improvement in the performance by using both tests. Among patients at risk for IPA , the diagnostic performance of LFD and GM in BAL fluid appears comparable; specificity is high, but sensitivity of both LFD and GM is poor.