Galactomannan in bronchoalveolar lavage fluid - A tool for diagnosing aspergillosis in intensive care unit patients
Galactomannan in bronchoalveolar lavage fluid - A tool for diagnosing aspergillosis in intensive care unit patients
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DOI：
10.1164/rccm.200704-606oc
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发表时间：
2008-01-01
影响因子：
24.7
通讯作者：
Van Wijngaerden, Eric
中科院分区：
文献类型：
--
作者：
Meersseman, Wouter;Lagrou, Katrien;Van Wijngaerden, Eric
依据：侵袭性曲霉菌病（IA）是恶性血液病患者死亡的重要原因。然而，IA似乎在重症监护室（ICU）中没有经典危险因素的患者中站稳脚跟。最近的一项研究描述了89例IA患者在医疗ICU没有白血病或癌症。IA的诊断仍然很困难，而且往往建立得太晚。半乳甘露聚糖（GM）是一种外抗原释放的曲霉菌菌丝，而他们侵入宿主tissue.Objectives：这项前瞻性单中心研究进行了调查的作用，GM在支气管肺泡灌洗（BAL）液作为一种工具，IA的早期诊断在ICU。方法：所有患者的危险因素，在我们早期的研究进行了评估。对所有有肺炎体征的患者进行BAL培养和GM检测、血清GM水平和计算机断层扫描。患者被分类为已证实的，可能的，或可能的IA。测量和主要结果：共110例患者的1109个入院资格。有26例确诊的IA病例。使用临界指数0.5，BAL液中GM检测的灵敏度和特异性分别为88%和87%。血清GM的敏感性仅为42%。在26例确诊病例中，11例BAL培养和血清GM仍为阴性，而BAL中GM为阳性。结论：IA常见于免疫功能低下的危重患者。BAL液中GM检测似乎有助于确定或排除ICU中IA的诊断。
Rationale: Invasive aspergillosis (IA) is an important cause of mortality in patients with hematologic malignancies. However, IA appears to be gaining a foothold in the intensive care unit (ICU) in patients without classical risk factors. A recent study described 89 cases of IA in patients in a medical ICU without leukemia or cancer. The diagnosis of IA remains difficult and is often established too late. Galactomannan (GM) is an exo-antigen released from Aspergillus hyphae while they invade host tissue.Objectives: This prospective single-center study was conducted to investigate the role of GM in bronchoalveolar lavage (BAL) fluid as a tool for early diagnosis of IA in the ICU.Methods: All patients with risk factors identified in our earlier study were evaluated. BAL for culture and GM detection, serum GM levels, and computed tomography scan were obtained for all included patients with signs of pneumonia. Patients were classified as having proven, probable, or possible IA.Measurements and Main Results: A total of 110 patients out of 1, 109 admissions were eligible. There were 26 proven IA cases. Using a cutoff index of 0.5, the sensitivity and specificity of GM detection in BAL fluid was 88 and 87%, respectively. The sensitivity of serum GM was only 42%. In 11 of 26 proven cases, BAL culture and serum GM remained negative, whereas GM in BAL was positive.Conclusions: IA is common in immunocompromised, critically ill patients. GM detection in BAL fluid seems to be useful in establishing or excluding the diagnosis of IA in the ICU.