Bronchoalveolar lavage lateral-flow device test for invasive pulmonary aspergillosis diagnosis in haematological malignancy and solid organ transplant patients

doi:10.1016/j.jinf.2012.10.003

Journal of Infection

Volume 65, Issue 6, December 2012, Pages 588-591

https://doi.org/10.1016/j.jinf.2012.10.003 Get rights and content

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Transparency declaration

LFD tests used in this study were provided by Dr C. Thornton, University of Exeter. No other funding was obtained for this study.

Potential conflicts of interest

M. Hoenigl received research grant from Merck; speakers fee from Astellas and Merck.

All other authors no conflict.

Acknowledgement

We acknowledge the help of Brigitta Waitzl in sample organization and preparation.

References (10)

S.Y. Park et al.
Aspergillus galactomannan antigen assay in bronchoalveolar lavage fluid for diagnosis of invasive pulmonary aspergillosis
J Infect
(2010 Dec)
M. Hoenigl et al.
Impact of galactomannan testing on the prevalence of invasive aspergillosis in patients with hematological malignancies
Med Mycol
(2012 Apr)
C. Thornton et al.
Detection of invasive pulmonary aspergillosis in haematological malignancy patients by using lateral-flow technology
J Vis Exp
(2012 Mar 22)
C.R. Thornton
Development of an immunochromatographic lateral-flow device for rapid serodiagnosis of invasive aspergillosis
Clin Vaccine Immunol
(2008 Jul)
N.P. Wiederhold et al.
Comparison of lateral flow technology and galactomannan and (1->3)-beta-D-glucan assays for detection of invasive pulmonary aspergillosis
Clin Vaccine Immunol
(2009 Dec)

There are more references available in the full text version of this article.

Cited by (65)

The performance of galactomannan in combination with 1,3-β-D-glucan or aspergillus-lateral flow device for the diagnosis of invasive aspergillosis: Evidences from 13 studies
2019, Diagnostic Microbiology and Infectious Disease
Citation Excerpt :
The Fagan nomogram (Fagan, 1975) was used to assess the clinical utility of the combined performance of GM and BDG assays, which demonstrated that the possibility of having IA was heightened 3.6-fold when the two tests had at least one positive result, and declined to 2% with both negative results (Fig. 5). Seven studies provided combined diagnostic data of GM and LFD test for proven/probable IA versus possible or no IA, of which five studies (Hoenigl et al., 2012, 2014; Miceli et al., 2015; Prattes et al., 2014, 2015) evaluated the two assays with BAL samples and two studies(Held et al., 2013; White et al., 2013) with serum samples. When at least one positivity of GM or LFD (GM/LFD) was defined for the true positive result, the pooled SEN, SPE, PLR, NLR, DOR and AUC were 0.93, 0.82, 5.11, 0.08, 62.77 and 0.91, respectively, with substantial heterogeneity (Q-test = 7.69, P = 0.011, I2 = 73.98%) (Figs. 6 and 7).
Galactomannan (GM), 1,3-β-D-glucan (BDG) and aspergillus-lateral flow device (LFD) are recognized as diagnostic tools for invasive aspergillosis (IA). The combined performance of these assays, however, is inconsistent in various studies. We undertook a meta-analysis of 13 studies involving 1513 patients to evaluate the utility of GM in combination with BDG or LFD for diagnosing IA. The pooled SEN, SPE, PLR, NLR and diagnostic odds ratio (DOR) were calculated and constructed to summarize the overall combined performance. Combining both positive results of GM and BDG assays leaded to the pooled SEN 0.49 (95%CI 0.27–0.72), SPE 0.98 (95%CI 0.94–1.00), PLR 31.68 (95%CI 5.36–187.37), NLR 0.52 (95%CI 0.32–0.84) and DOR 61.23 (95%CI 6.96–538.90). Comparing with GM and BDG assays, both positive results of GM and LFD leaded to high SEN, similar SPE, low PLR and NLR. At least one positive result of GM or LFD conferred great SEN 0.93 and low NLR 0.08. Both positive results of GM and BDG or LFD assay were in favor of confirming the existence of IA. And both negative results of GM and LFD were beneficial to rule out IA. Further studies with sufficient sample size should focus on the diagnostic performance and cost-effectiveness of these combined tests in clinical setting.
Diagnosis and management of Aspergillus diseases: executive summary of the 2017 ESCMID-ECMM-ERS guideline
2018, Clinical Microbiology and Infection
The European Society for Clinical Microbiology and Infectious Diseases, the European Confederation of Medical Mycology and the European Respiratory Society Joint Clinical Guidelines focus on diagnosis and management of aspergillosis. Of the numerous recommendations, a few are summarized here. Chest computed tomography as well as bronchoscopy with bronchoalveolar lavage (BAL) in patients with suspicion of pulmonary invasive aspergillosis (IA) are strongly recommended. For diagnosis, direct microscopy, preferably using optical brighteners, histopathology and culture are strongly recommended. Serum and BAL galactomannan measures are recommended as markers for the diagnosis of IA. PCR should be considered in conjunction with other diagnostic tests. Pathogen identification to species complex level is strongly recommended for all clinically relevant Aspergillus isolates; antifungal susceptibility testing should be performed in patients with invasive disease in regions with resistance found in contemporary surveillance programmes. Isavuconazole and voriconazole are the preferred agents for first-line treatment of pulmonary IA, whereas liposomal amphotericin B is moderately supported. Combinations of antifungals as primary treatment options are not recommended. Therapeutic drug monitoring is strongly recommended for patients receiving posaconazole suspension or any form of voriconazole for IA treatment, and in refractory disease, where a personalized approach considering reversal of predisposing factors, switching drug class and surgical intervention is also strongly recommended. Primary prophylaxis with posaconazole is strongly recommended in patients with acute myelogenous leukaemia or myelodysplastic syndrome receiving induction chemotherapy. Secondary prophylaxis is strongly recommended in high-risk patients. We strongly recommend treatment duration based on clinical improvement, degree of immunosuppression and response on imaging.
Bronchoalveolar lavage triacetylfusarinine C (TAFC) determination for diagnosis of invasive pulmonary aspergillosis in patients with hematological malignancies
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Letter to the EditorBronchoalveolar lavage lateral-flow device test for invasive pulmonary aspergillosis diagnosis in haematological malignancy and solid organ transplant patients

Section snippets

Transparency declaration

Potential conflicts of interest

Acknowledgement

J Infect

Impact of galactomannan testing on the prevalence of invasive aspergillosis in patients with hematological malignancies

Med Mycol

Detection of invasive pulmonary aspergillosis in haematological malignancy patients by using lateral-flow technology

J Vis Exp

Development of an immunochromatographic lateral-flow device for rapid serodiagnosis of invasive aspergillosis

Clin Vaccine Immunol

Comparison of lateral flow technology and galactomannan and (1->3)-beta-D-glucan assays for detection of invasive pulmonary aspergillosis

Clin Vaccine Immunol

Letter to the Editor
Bronchoalveolar lavage lateral-flow device test for invasive pulmonary aspergillosis diagnosis in haematological malignancy and solid organ transplant patients