Increasing survival rate of invasive pulmonary aspergillosis (IA) among hematological malignancy patients requires early diagnosis and treatment initiation. Triacetylfusarinine C (TAFC) is a siderophore produced by Aspergillus fumigatus. Promising results for IA diagnosis in animal models for TAFC have been published previously. Here we evaluated the diagnostic performance of combinations of TAFC, the Aspergillus specific Lateral Flow Device Test (LFD) and galactomannan (GM) in bronchoalveolar lavage fluid (BALF) samples obtained from hematological malignancy patients.
A total of 44 BALF samples, obtained from 44 patients with hematological malignancies between 2010 and 2015 (15 patients with proven or probable IA and 29 controls with no IA who were matched by age and underlying diseases) were included in this analysis. GM and LFD were performed prospectively in all samples. Samples were thereafter stored at -70°C for retrospective determination of TAFC. GM optical density index ≥0.5 and TAFC ≥1 were considered positive. IA was classified according to modified EORTC/MSG criteria.
Among the 15 patients with IA median age was 61 years (range 41-83) and most frequent underlying disease was AML (9/15). Sensitivity, specificity, positive (PPV) and negative predictive values (NPV) for TAFC, GM and LFD as well as combinations are displayed in the table. The combination of either TAFC or GM resulting positive exhibited 87% sensitivity (PPV 100%), while the combination of both TAFC and GM resulting positive exhibited 100% specificity (NPV 91%).
The combination of TAFC and/or GM in BALF was promising for confirming and ruling out IA. More studies regarding this new and promising biomarker need to be performed to define the optimal cut-off and investigate the diagnostic performance in larger patient cohorts.
S. Eigl, None
S. Heldt, None
W. Duettmann, None
K. Faserl, None
H. Lindner, None
H. Haas, None
M. Hoenigl, None