2040. Clinical application of Aspergillus lateral flow device (AspLFD) in bronchoalveolar lavage (BAL) fluid of patients (pt) with classic risk factors for invasive pulmonary aspergillosis (IPA)
Session: Poster Abstract Session: Diagnostics: Mycology
Saturday, October 6, 2018
Room: S Poster Hall
Posters
  • LFD poster FINAL.pdf (1.3 MB)
  • Background: IPA causes high morbidity & mortality in immunocompromised pt, but diagnosis remains challenging. A newly formatted AspLFD targets specific Aspergillus antigen JF5, but reported results for this test are variable. We evaluated the performance characteristics of this new AspLFD in BAL fluid of pt with IPA.

    Methods: Samples tested were from pt with classic risk factors for IPA defined by EORTC/MSG criteria & that had been prospectively banked in our BAL repository. Each case of IPA identified was matched to 2 high-risk control pt without IPA or other invasive fungal infection. Samples were thawed, vortexed, centrifuged, & 100μl of supernatant was applied to the AspLFD. Results were interpreted at 15 min as +, ++, +++, or negative by 3 independent, blinded observers. Test characteristics, including sensitivity, specificity, positive predictive value (PPV) & negative predictive value (NPV) were calculated.

    Results: Samples from 14 pt with proven/probable IPA by EORTC/MSG criteria and 28 control pt without IPA were tested. Median age was 58 (range 22-87); 28 were men. Age & gender distribution were similar between cases & controls. Among IPA cases, 9 were on T cell depleting agents, 4 on high-dose steroids, & 3 had prolonged neutropenia. Among non-IPA controls, risk factors were T cell depleting agents (17), high-dose steroids (11), and stem cell transplant (2). Of the 14 pt with IPA, AspLFD was positive in 3, negative in 9; in 2, the internal control line did not display & these were considered invalid. Of 6 pt receiving an azole, 3 had a positive AspLFD test. AspLFD was negative for all 28 BAL in the non-IPA group. AspLFD showed low sensitivity (25%) & high specificity (100%); PPV was 100% & NPV was 75%. Accuracy of the test was 77.5%.

    Conclusion: A positive AspLFD test in BAL of pt with classic risk factors for IPA could be useful for ruling in proven/probable IPA because of its high specificity. However, the use of AspLFD as a screening test for IPA is limited by its poor sensitivity.

    Kathleen A. Linder, MD1, Shiwei Zhou, MD1, Carol A. Kauffman, MD2 and Marisa H. Miceli, MD1, (1)Division of Infectious Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, (2)Division of Infectious Diseases, Department of Internal Medicine, University of Michigan and Ann Arbor VA Healthcare System, Ann Arbor, MI

    Disclosures:

    K. A. Linder, None

    S. Zhou, None

    C. A. Kauffman, None

    M. H. Miceli, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 3rd with the exception of research findings presented at the IDWeek press conferences.