Author/Authors :
K hodavaisy ، S نويسنده Department of Medical Mycology and Parasitology, Kurdistan University of M edical Sciences, Sanandaj, Iran , , Hedayati ، MT نويسنده nvasive Fungi Research Center, Mazand aran University of Medical Sciences, Sari, Iran , , Alialy ، M نويسنده Department of Pulmonary and Critical Care Division, Mazandaran University of Medical Sciences, Sari, Ir an , , Habibi ، MR نويسنده Department of Anesthesiologist and Critical Care Division, Mazandaran University o f Medical Sciences, Sari, Iran , , Badali ، H نويسنده Department of Medical Mycology and Parasitology, Mazandaran University o f Medical Sciences, Sari, Iran ,
Abstract :
Background and Purpose
:
Invasive aspergillosis (IA) is one of the most common life
-
threatening fungal infections
among
the
critically ill patients including intensive care unit (ICU) patients. Delayed diagnosis and therapy may lead t
o
poor outcomes. Diagnosis may be facilitated by a test for molecular biomarkers, i.e. detection of galactomannan (GM)
antigen based on enzyme immunoassay, which is of increasing interest in
the
clinical settings for
the
diagnosis of IA. In
the present stu
dy
,
we assessed GM tes
ting of bronchoalveolar lavage (BAL) fluid as a tool for early diagnosis of IA
among ICU patients who were at risk for developing IA.
Material and Methods:
A prospective study was performed in ICU patients with underlying predisposing conditions
for IA betw
een August 2010 and September 2011
. BAL samples for direct microscopic examination, culture, and GM
detection were obtained once or twice weekly. GM in BAL levels was measured using the Platellia Aspergillus EIA test
kit. According to modified European Org
anization for the Research and Treatment of Cancer/ Mycoses Study Group
(EORTC/MSG) criteria, patients were classified as having probable or possible IA.
Results:
Out of 43 suspected patients to IA, 13 (30.2%) cases showed IA. According to
the
criteria pre
sented by
EORTC/MSG, they were categorized as: 4 cases (30.8%) of possible IA and 9 (69.2%) of probable IA. Out of 21 BAL
samples from patients with IA, 11 (52.4%) had at least one positive BAL GM index. Using a cutoff index of 0.5, the
sensitivity and spe
cificity, positive and negative predictive values of GM detection in BAL fluid were 100%, 85.7%,
65.7% and 96%, respectively. The sensitivity and specificity was 73% and 92.7% at cut
off ?1.0, respectively. In 6 of 13
IA cases, BAL culture or direct microscopic examination remained negative, whereas GM in BAL was positive.
Conclusion:
Our data have revealed that the sensitivity of GM detection in BAL was better than that of convention
al
tests. It seems that GM detection in BAL is beneficial to establish or exclude
the
early diagnosis of IA in ICU patients.
