Journal Article

Comparison of an <i>Aspergillus</i> Real-time Polymerase Chain Reaction Assay With Galactomannan Testing of Bronchoalvelolar Lavage Fluid for the Diagnosis of Invasive Pulmonary Aspergillosis in Lung Transplant Recipients

Me-Linh Luong, Cornelius J. Clancy, Aniket Vadnerkar, Eun Jeong Kwak, Fernanda P. Silveira, Mark C. Wissel, Kevin J. Grantham, Ryan K. Shields, Maria Crespo, Joseph Pilewski, Yoshiya Toyoda, Steven B. Kleiboeker, Diana Pakstis, Sushruth K. Reddy, Thomas J. Walsh and M. Hong Nguyen

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 52, issue 10, pages 1218-1226
Published in print May 2011 | ISSN: 1058-4838
Published online May 2011 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1093/cid/cir185
Comparison of an Aspergillus Real-time Polymerase Chain Reaction Assay With Galactomannan Testing of Bronchoalvelolar Lavage Fluid for the Diagnosis of Invasive Pulmonary Aspergillosis in Lung Transplant Recipients

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Background. Early diagnosis and treatment of invasive pulmonary aspergillosis (IPA) improves outcome.

Methods. We compared the performance of publicly available pan-Aspergillus–Aspergillus fumigatus–, and Aspergillus terreus–specific real-time polymerase chain reaction (PCR) assays with the Platelia galactomannan (GM) assay in 150 bronchoalveolar lavage (BAL) samples from lung transplant recipients (16 proven/probable IPA, 26 Aspergillus colonization, 11 non-Aspergillus mold colonization, and 97 negative controls).

Results. The sensitivity and specificity of pan-Aspergillus PCR (optimal quantification cycle [Cq], ≤35.0 by receiver operating characteristic analysis) and GM (≥.5) for diagnosing IPA were 100% (95% confidence interval, 79%–100%) and 88% (79%–92%), and 93% (68%–100%) and 89% (82%–93%), respectively. The sensitivity and specificity of A. fumigatus–specific PCR were 85% (55%–89%) and 96% (91%–98%), respectively. A. terreus–specific PCR was positive for the 1 patient with IPA due to this species; specificity was 99% (148 of 149 samples). Aspergillus PCR identified 1 patient with IPA not diagnosed by GM. For BAL samples associated with Aspergillus colonization, the specificity of GM (92%) was higher than that of pan-Aspergillus PCR (50%; P = .003). Among negative control samples, the specificity of pan-Aspergillus PCR (97%) was higher than that of BAL GM (88%; P = .03). Positive results for both BAL PCR and GM testing improved the specificity to 97% with minimal detriment to sensitivity (93%).

Conclusions. A recently developed pan-Aspergillus PCR assay and GM testing of BAL fluid may facilitate the diagnosis of IPA after lung transplantation. A. fumigatus– and A. terreus–specific real-time PCR assays may be useful in rapidly identifying the most common cause of IPA and a species that is intrinsically resistant to amphotericin B, respectively.

Journal Article.  4827 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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