Performance of Galactomannan, Beta-D-Glucan, Aspergillus Lateral-Flow Device, Conventional Culture, and PCR Tests with Bronchoalveolar Lavage Fluid for Diagnosis of Invasive Pulmonary Aspergillosis
Performance of Galactomannan, Beta-D-Glucan, Aspergillus Lateral-Flow Device, Conventional Culture, and PCR Tests with Bronchoalveolar Lavage Fluid for Diagnosis of Invasive Pulmonary Aspergillosis
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DOI：
10.1128/jcm.00467-14
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发表时间：
2014-06-01
影响因子：
9.4
通讯作者：
Buchheidt, D.
中科院分区：
文献类型：
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作者：
Hoenigl, M.;Prattes, J.;Buchheidt, D.
支气管肺泡灌洗液(BAL)中半乳甘露聚糖的检测(GM试验)目前被认为是诊断侵袭性肺曲霉菌病(IPA)的金标准试验。然而，限制是不同的周转时间和测试的可用性。我们比较了GM检测与常规培养、曲霉侧向流动装置(LFD)检测、β-D-葡聚糖(BDG)检测和曲霉PCR检测的性能。研究对象包括2012年12月至2013年5月在奥地利和德国的两所大学医院收集的78名IPA高危患者的78份BAL液体样本(74份来自格拉茨，4份来自曼海姆)。3名患者已证实有IPA，14名患者可能有IPA，17名患者可能有IPA，44名患者没有IPA。评估不同方法对可能的或已证实的IPA的诊断准确性。GM、PCR和LFD测试的诊断优势比最高。四种方法(培养法除外)的敏感性在70%~88%之间。GM(截止光密度指数[ODI]，>；1.0)和LFD试验的结合使敏感性提高到94%，而GM(>；1.0)和PCR的结合导致100%的敏感性(对可能/证实的IPA的特异性为95%到98%)。常规培养的敏感性较低，而BDG试验的特异性较低。我们评估了已建立的和新的IPA诊断方法，发现曲霉PCR、LFD和GM测试是使用BAL液体样本诊断该病的最有用的方法。特别是，转基因检测和聚合酶链式反应，或者，如果没有聚合酶链式反应，LFD检测的组合，允许对IPA进行敏感和特异的诊断。
Galactomannan detection in bronchoalveolar lavage (BAL) fluid samples (GM test) is currently considered the gold standard test for diagnosing invasive pulmonary aspergillosis (IPA). The limitations, however, are the various turnaround times and availability of testing. We compared the performance of GM testing with that of conventional culture, an Aspergillus lateral-flow-device (LFD) test, a beta-D-glucan (BDG) test, and an Aspergillus PCR assay by using BAL fluid samples from immunocompromised patients. A total of 78 BAL fluid samples from 78 patients at risk for IPA (74 samples from Graz and 4 from Mannheim) collected between December 2012 and May 2013 at two university hospitals in Austria and Germany were included. Three patients had proven IPA, 14 probable IPA, and 17 possible IPA, and 44 patients had no IPA. The diagnostic accuracies of the different methods for probable/proven IPA were evaluated. The diagnostic odds ratios were the highest for the GM, PCR, and LFD tests. The sensitivities for the four methods (except culture) were between 70 and 88%. The combination of the GM (cutoff optical density index [ODI],> 1.0) and LFD tests increased the sensitivity to 94%, while the combination of the GM test (> 1.0) and PCR resulted in 100% sensitivity (specificity for probable/proven IPA, 95 to 98%). The performance of conventional culture was limited by low sensitivity, while that of the BDG test was limited by low specificity. We evaluated established and novel diagnostic methods for IPA and found that the Aspergillus PCR, LFD, and GM tests were the most useful methods for diagnosing the disease by using BAL fluid samples. In particular, the combination of the GM test and PCR or, if PCR is not available, the LFD test, allows for sensitive and specific diagnosis of IPA.