Comparison of Bronchoalveolar Lavage Fluid Galactomannan and Aspergillus PCR for Diagnosis Invasive Pulmonary Aspergillosis in Neutropenic Patients
Itthiphat Arunsurat¹, Apichart So-Ngern², Paramet Bumroongsawat¹, Wipa Reechaipichitkul¹, Atibordee Meesing³, Pailin Ratanawatkul¹, Worawat Chumpangern¹
Affiliation : ¹ Subdivision of Pulmonary Medicine and Pulmonary Critical Care, Division of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand ² Subdivision of Sleep Medicine, Division of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand ³ Subdivision of Infectious diseases and Tropical medicine, Division of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
Background: Aspergillus polymerase chain reaction (PCR) represents a novel method for diagnosing invasive pulmonary aspergillosis (IPA). However, studies of comparison of bronchoalveolar fluid (BALF) galactomannan (GM) and Aspergillus PCR remain limited.
Objective: To compare the BALF GM and Aspergillus PCR for diagnosis of IPA.
Materials and Methods: A cross-sectional study was conducted at Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, between January 1, 2019, and December 31, 2022. The study enrolled neutropenic patients aged ≥18 years with radiological findings suggestive of IPA, serum galactomannan <0.5, and who underwent bronchoscopy with BAL.
Results: Forty-five subjects were recruited. 23 (51.1%) were male. The mean (SD) age was 52.6 (17.8) years. Common underlying diseases included lymphoma (37.8%), leukemia (33.3%), and systemic lupus erythematosus (20.0%). The median (IQR) absolute neutrophil count was 192 (32 to 132) cell/mm3. BALF GM ≥1.0 occurred in 19 subjects (42.0%), while BALF Aspergillus PCR occurred in 37 subjects (82.2%). The diagnostic sensitivity of BALF Aspergillus PCR was significantly higher than that of BALF GM (p<0.001), and the highest diagnostic sensitivity was achieved with the combined use of BALF Aspergillus PCR and BALF GM, the sensitivity was 93.3%.
Conclusion: Aspergillus PCR enhances the diagnostic yield of IPA. BALF GM and Aspergillus PCR should be utilized for diagnosing IPA in neutropenic patients with suspected radiological findings.
Received 28 February 2024 | Revised 1 July 2024 | Accepted 8 July 2024
DOI: 10.35755/jmedassocthai.2024.S01.S95-S99
Keywords : Bronchoalveolar fluid; Galactomannan, Aspergillus PCR
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