1045. Usefulness of Aspergillus Galactomannan in BAL Fluid for the Diagnosis of IPA in Immune–compromised Patients
Session: Poster Abstract Session: Fungal Diagnosis
Saturday, October 22, 2011
Room: Poster Hall B1
Handouts
  • 1045_AnaPaulaOppenheimer_sm.pdf (1.8 MB)
  • Background: Detection of Aspergillus galactomannan in bronchoalveolar lavage fluid (BALF AG) is growing more important in the diagnosis of Invasive Pulmonary Aspergillosis (IPA). The objective of this study was to assess the clinical usefulness of BAL AG by immunoassay for the diagnosis of IPA in immunocompromised patients. 

    Methods: From May-2008 to July-2010, 166 samples from 119 patients admitted to the Hematology /Oncology service of a tertiary institution were tested for BALF AG as part of clinical evaluation for IPA. In 124 (75%) cases a single sample was collected, and in 42 (25%) multiple samples were collected for testing from the same bronchoscopic procedure. A positive test result was defined as BALF AG index ≥0.5 and a negative as <0.5. Demographic, clinical, radiologic, microbiologic, histopathologic and therapeutic, and outcomes variables were analyzed. We evaluated sensitivity, specificity, and predictive values and compared them to clinical findings and culture results. We utilized the definition of proven, probable and possible IPA proposed by EORTC/MSG. T-test and chi-square were used for statistical significance. 

    Results: A total of 27 positive results were obtained. Females had a lower proportion of positive BALF AG than did males (10% x 29%, p<0.025), and non-Whites had a higher proportion of positive BALF AG than did Whites (40% x 17.3%, p<0.025). Radiologic findings (halo sign and cavities within nodular consolidations were significant in BALF AG positive group (p<0.025). Differences in age, length of stay, duration of neutropenia, duration of immunosuppression, and outcomes were not significant between positive and negative BALF AG groups. More deaths occurred in males versus females (p<0.025). Compared to culture and clinical findings, BALF AG performance was as follows: sensitivity 75%, specificity 91%, PPV 62.5%, NPV 95% and accuracy 88%. Of the positive BALF AG group, 18% had a negative fungal culture, 33% grew Aspergillus spp; 19% each grew Candida and Penicillium spp, and 11% grew other molds. 

    Conclusion: This study demonstrated that BALF AG may be useful in the diagnosis of IPA. Although a positive test does not accurately predict the presence of infection , the high NPV is especially important to rule out the diagnosis of IPA. 


    Subject Category: M. Mycology including clinical and basic studies of fungal infections

    Ana Paula Oppenheimer, M.D. MPH, Medicine- Infectious Diseases, Wake Forest Baptist Medical Center, Winston Salem, NC and Elizabeth Palavecino, MD, Pathology, Wake Forest School of Medicine, Winston Salem, NC

    Disclosures:

    A. P. Oppenheimer, None

    E. Palavecino, None

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