PT  - JOURNAL ARTICLE
AU  - Affolter, Kristina
AU  - Jahn, Kathleen
AU  - Wehrle-Wieland, Elisabeth
AU  - Goldenberger, Daniel
AU  - Tamm, Michael
AU  - Khanna, Nina
AU  - Stolz, Daiana
AU  - Halter, Jörg
AU  - Passweg, Jakob
TI  - Fungal PCR in the bronchoalveolar lavage for diagnosing invasive fungal disease
AID  - 10.1183/13993003.congress-2015.PA571
DP  - 2015 Sep 01
TA  - European Respiratory Journal
PG  - PA571
VI  - 46
IP  - suppl 59
4099  - http://erj.ersjournals.com/content/46/suppl_59/PA571.short
4100  - http://erj.ersjournals.com/content/46/suppl_59/PA571.full
SO  - Eur Respir J2015 Sep 01; 46
AB  - Rationale: Invasive fungal disease is a significant cause of morbidity and mortality in immunocompromised patients.Objectives: We hypothesize that detection of fungal DNA,measured in the bronchoalveolar lavage,might be a diagnostic adjunct in hematological malignancies.Methods: 179 hematological cases undergoing diagnostic bronchoscopy due to suspected IFD between 2011 and 2013 at a tertiary care center in Switzerland were included in this prospective, observational cohort study. We compared accuracy of the BAL panfungal PCR and the newly developed molecular PCR detection system for Aspergillus and Mucorales sp. for predicting IFD as classified by the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group definition.Measurements and Main Results: According to the EORTC/MSG criteria, IFD was classified as possible in 40 (22.3%), probable in 40 (22.3%) and proven in 2 (1.1%).Panfungal, Aspergillus and Mucorales PCR showed positive results in 94, 13 and 6 cases (52.5%, 7.2% and 3.3%, respectively).The positive results of the panfungal PCR mostly represented a mixture of fungal DNA (45 cases, 47.9%) and colonization (24, 25.5%).In 12 (12.8%) cases genus of non-pathogenic fungi were detected.Only in a minority potentially pathogenic fungi were detected (2 Alternaria, 2 Cladosporium sp., 2 Aspergillus fumigatus).Aspergillus PCR provided 23.8% sensitivity, 97.8% specificity, 76.9% PPV, 80.7% NPV, 10.87 PLR and 0.78 NLR for diagnosing proven + probable IFD. Corresponding values for panfungal PCR were 7.14%, 97.81%, 50%, 77.5%, 3.26 and 0.95.Conclusion: Aspergillus PCR in the bronchoalveolar fluid could be useful in excluding IFD in immunocompromised patients.