THE DETECTION OF 1,3-?-D-GLUCAN DETECTION IN BRONCHOALVEOLAR LAVAGE FLUID FOR THE DIAGNOSIS OF INVASIVE PULMONARY ASPERGILLOSIS IN HEMATOLOGICAL PATIENTS

Sborník

Background. Invasive pulmonary aspergillosis (IPA) is a severe infectious complication of hematological patients and its early diagnosis can contribute to the improvement of survival of affected patients. Aims. To evaluate the contribution of 1,3-β-D-glucan (BG) performed from bronchoalveolar lavage (BAL) fluid to IPA diagnosis. Methods. A retrospective analysis of BG detection in BAL fluid performed in 163 hematological patients between 1/2007 and 12/2011. Proven IPA (EORTC/MSG 2008 criteria) was documented in 2.6% (5 pts.), probable IPA in 10.7% (20 pts.) and possible IPA in 40.0% (75 pts). 46.7% (87 pts.) without evidence of IPA were considered as negative control. Pneumocystis pneumonia was diagnosed in 7.0% (13 cases) and positive culture from BAL fluid for Candida sp. was in 4.8 % (9 cases). Oral cavity colonization with Candida sp. was detected in 33.7% (63 cases). Results. 187 samples were included in the analysis. 48% (12/25 pts) of samples from proven/probable IPA pts were positive (> 80 pg/ml) and 12% (3/25) were intermediate (60-80 pg/ml). 37% (32/87) samples from pts without IPA were positive and 2% (2/87) were intermediate. After the exclusion of samples with pneumocystis pneumonia, the number of positive and intermediate results decreased to 32%.The mean BAL BG for patients with proven and probable IPA was 79 pg/ml (range 0-1145), for possible IPA 13 pg/ml (range 0-534) and for negative control 55 pg/ml (range 0-1477).The frequency of false positive results (>80 pg/ml) in our study was 29%. There was no difference between the mean BAL BG in the control group with or without oral cavity colonization with Candida sp. (43 vs. 32 pg/ml respective).The performance of glucan in BAL fluid tested at various cutoffs is presented in the table. Summary and Conclusions. The performance of glucan in BAL fluid has acceptable sensitivity, but a low specificity and positive predictive value for the diagnosis of invasive pulmonary aspergillosis. Moreover, due to “panfungality”of the assay it is necessary to use a combination of methods (ie galactomannan or PCR) for the confirmation of IPA.Supported by Masaryk University MUNI/A/0784/2011.

Haematologica, 2012; 97(s1):  176