期刊
MYCOSES
卷 64, 期 9, 页码 1124-1131出版社
WILEY
DOI: 10.1111/myc.13269
关键词
antifungal agents; aspergillosis; bronchoalveolar lavage; galactomannan; immunocompromised host; invasive fungal infections; invasive pulmonary aspergillosis; opportunistic infection
资金
- Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI) - Ministry of Health & Welfare, Republic of Korea [HI20C0073]
This study investigated the diagnostic performance of bronchoalveolar lavage (BAL) fluid galactomannan (GM) assay in patients suspected of invasive pulmonary aspergillosis (IPA) with negative serum GM results. The results showed that sequential BAL in these patients provided additional diagnostic yield in approximately half of the cases, while also revealing evidence of other opportunistic infections.
Background and objectives There are limited data in real clinical practice on the diagnostic value of a bronchoalveolar lavage (BAL) fluid galactomannan (GM) assay in patients with suspected invasive pulmonary aspergillosis (IPA) who had negative serum GM results. Thus, we investigated the diagnostic performance of a BAL GM assay in patients with negative serum GM assay results who were suspected to have IPA. Methods This retrospective study was performed between May 2008 and April 2019 at a tertiary-care hospital in Seoul, South Korea. All patients with suspected IPA whose serum GM assays revealed negative results who sequentially underwent BAL were enrolled in this study. Results A total of 341 patients with suspected IPA including four cases of proven IPA, 38 cases of probable IPA, 107 cases of possible IPA and 192 patients without IPA were enrolled. Of these 341 patients, 107 (31%) with possible IPA were excluded from the final analysis. Of 42 patients with proven and probable IPA who had initial negative serum GM results, 24 (57%) had positive BAL GM results (n = 24) or BAL fungal culture results (n = 8). In addition, BAL revealed evidence of other opportunistic infections including Pneumocystis jirovecii pneumonia (14% [26/190]), cytomegalovirus (CMV) pneumonia (5% [9/188]) and respiratory viral pneumonia (6% [12/193]). Conclusion Sequential BAL in patients with suspected IPA who had initial negative serum GM results provided additional diagnostic yield in approximately half of patients with evidence of another co-infection.
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