RT Journal Article
SR Electronic
T1 Fungal PCR in the bronchoalveolar lavage for diagnosing invasive fungal disease
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP PA571
DO 10.1183/13993003.congress-2015.PA571
VO 46
IS suppl 59
A1 Affolter, Kristina
A1 Jahn, Kathleen
A1 Wehrle-Wieland, Elisabeth
A1 Goldenberger, Daniel
A1 Tamm, Michael
A1 Khanna, Nina
A1 Stolz, Daiana
A1 Halter, Jörg
A1 Passweg, Jakob
YR 2015
UL http://erj.ersjournals.com/content/46/suppl_59/PA571.abstract
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.