1558. Diagnostic performance of bronchoalveolar lavage triacetylfusarinine C (TAFC) determination for invasive pulmonary aspergillosis in patients with hematological malignancies
Session: Poster Abstract Session: Mycology: Diagnostic
Friday, October 28, 2016
Room: Poster Hall
Posters
  • TAFC in BAL_ID Week 2016_final.pdf (1.3 MB)
  • Background:

    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.

    Methods:

    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.

    Results:

    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%).

    Sensitivity

    Specificity

    PPV

    NPV

    TAFC

    0.40

    0.75

    0.46

    0.71

    GM*

    0.73

    0.97

    0.92

    0.88

    LFD

    0.47

    0.83

    0.59

    0.75

    TAFC and GM#

    0.27

    1

    1

    0.73

    TAFC or GM

    0.87

    0.71

    0.62

    0.91

    TAFC and LFD

    0.20

    0.97

    0.75

    0.7

    TAFC or LFD

    0.67

    0.62

    0.48

    0.78

    * GM was used for classification of IA leading to potential overestimation of diagnostic performance.

    # “and” indicates that both tests had to be positive; “or” indicates that one of the two tests had to be positive.

    Conclusion:

    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.

    Juergen Prattes, MD1, Thomas Orasch, Mag.pharm.2, Susanne Eigl, MD3, Sven Heldt, MD4, Wiebke Duettmann, MD5, Klaus Faserl, Dr. Mag.rer.nat.6, Herbert Lindner, Ph.D. Univ. Prof.7, Hubertus Haas, Ph.D. Assoc. Prof.2 and Martin Hoenigl, MD3, (1)Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria, (2)Division of Molecular Biology, Innsbruck Medical University, Innsbruck, Austria, (3)Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, Graz, Austria, (4)Medical University of Graz, Graz, Austria, (5)Section of Infectious Diseases and Tropical Medicine, Medical university of Graz, Graz, Austria, (6)Division of Clinical Biochemistry, Medical University of Innsbruck, Innsbruck, Austria, (7)Division of Clinical Biochemistry, Innsbruck Medical University, Innsbruck, Austria

    Disclosures:

    J. Prattes, None

    T. Orasch, None

    S. Eigl, None

    S. Heldt, None

    W. Duettmann, None

    K. Faserl, None

    H. Lindner, None

    H. Haas, None

    M. Hoenigl, None

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