Respiratory Care: Chest Infections |

Evaluation of Aspergillus Galactmannan, β-D-glucan, and Two Different Aspergillus-PCR Tests Using Bronchoalveolar Lavage Fluid for Diagnosis of Chronic Pulmonary Aspergillosis FREE TO VIEW

Naohisa Urabe, PhD; Susumu Sakamoto; Go Sano; Hiroshige Shimizu; Yasuhiko Nakamura; Yujiro Takai; Sakae Homma
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Toho University Omori Medical Center, Tokyo, Japan

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):1244A. doi:10.1016/j.chest.2016.08.1356
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SESSION TITLE: Chest Infections

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM

PURPOSE: To explore the more sensitive method for diagnosis of chronic pulmonary aspergillosis (CPA) using bronchoalveolar lavage fluid (BALF).

METHODS: We evaluated the Aspergillus galactmannan (GM), β-D-glucan (βDG) and two different Aspergillus-PCR assays by BALF samples from 18 patients with CPA group and 120 patients with control group who underwent bronchoscopic examination for making clinical diagnosis of pulmonary lesions. We also evaluated the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of each test. Receiver operating characteristic (ROC) analysis was performed to determine the cut off optical density index (ODI) of GM and βDG.

RESULTS: The subjects with CPA group comprised of 18 males with a mean age of 65.7 years. In the control group, the subjects comprised of 61 males and 59 females with a mean age of 67.6 years. Underlying lung diseases in control group were lung cancer, interstitial pneumonia and bronchiectasis in each of 40. The results of each test in CPA and control group were GM (2.75±1.92 vs 0.28±0.69), βDG (1790.2±3133.8 vs 134.3±301.9) pg/ml. The number of PCR positive cases in CPA and control group were (15/18 vs 19/120) in PCR1 and (13/18 vs 7/120) in PCR2. According to ROC analysis, ODI of GM and βDG were 0.7 and 120 pg/ml, respectively. The sensitivity, specificity, PPV and NPV of each test were as follows; GM test [86.7%, 92.5%, 59.1%, 98.2% (ODI >0.7)], βDG test [80%, 75%, 28.6%, 96.8% (ODI>120 pg/ml)], PCR1 (83.3%, 84.2%, 44.1%, 97.1%) and PCR2 (72.2%, 94.1%, 65%, 95.8%). As well as combination of two tests (GM + PCR1, GM + PCR2, βDG + PCR1, βDG + PCR2, GM + βDG) were as follows; GM + PCR1 (66.7%, 98.3%, 83.3%, 95.9%), GM + PCR2 (55.3%, 99.2%, 88.9%, 94.4%), βDG + PCR1 (60%, 96.7%, 69.2%, 95.1%), βDG + PCR2 (46.7%, 99.2%, 87.5%, 93.7%), GM + βDG (80%, 98.3%, 85.7%, 97.5%). GM test and two different Aspergillus-PCR assays using BALF samples were useful for making diagnosis of CPA. The combination of two tests showed higher PPV value than single tests. Especially, the values of sensitivity, specificity, PPV and NPV were more than 80% in combination of GM test with βDG test.

CONCLUSIONS: Among various assays for CPA diagnosis, combination of GM test with βDG test using BALF sample is more useful than single tests for making diagnosis of CPA.

CLINICAL IMPLICATIONS: Combination of GM test with βDG test using BALF sample is useful for making diagnosis of CPA.

DISCLOSURE: The following authors have nothing to disclose: Naohisa Urabe, Susumu Sakamoto, Go Sano, Hiroshige Shimizu, Yasuhiko Nakamura, Yujiro Takai, Sakae Homma

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