Diagnosis of invasive pulmonary aspergillosis in children with bronchoalveolar lavage galactomannan

Mark de Mol, Johan C de Jongste, Mireille van Westreenen, Peter J. F. M. Merkus, Andrica H. C. de Vries, Wim C. J. Hop, Adilia Warris, Hettie M. Janssens

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Abstract

BACKGROUND: Invasive pulmonary aspergillosis (IPA) is a life-threatening complication in immunocompromised patients. Early diagnosis and therapy improves outcome. Assessment of galactomannan (GM) in bronchoalveolar lavage (BAL) fluid is a proposed tool to diagnose IPA. Little is known about the diagnostic value of BAL GM in children.

MATERIALS AND METHODS: Retrospectively, 72 bronchoscopies were analyzed for GM in patients fulfilling the host factor criteria as defined by the EORTC/MSG. A cut-off index value GM of ≥0.5 was used. Clinical data, results of chest CT-scans and BAL cultures were collected.

RESULTS: Sensitivity, specificity, PPV, and NPV of BAL GM for a diagnosis of proven and probable IPA (n = 41) were 82.4%, 87.5%, 82.4%, and 87.5% respectively. A significant relation was found for BAL GM and abnormal chest CT (P = 0.01). No significant relationship was observed between BAL Aspergillus sp. culture and chest CT (n = 47). BAL GM and serum GM correlated significantly. In 9 out of 12 patients classified as possible IPA, antifungal therapy was continued or started, despite a negative BAL GM.

CONCLUSIONS: BAL GM test had good diagnostic value in children suspected of IPA. However, the decision to continue or start antifungal therapy was mainly determined by the clinical suspicion of IPA based on chest CT-outcome, serum GM index values and failure of antibiotic therapy.

Original languageEnglish
Pages (from-to)789-796
Number of pages8
JournalPediatric Pulmonology
Volume48
Issue number8
Early online date4 Sep 2012
DOIs
Publication statusPublished - Aug 2013

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Keywords

  • galactomannan
  • aspergillosis
  • bronchoalveolar lavage
  • children

Cite this

de Mol, M., de Jongste, J. C., van Westreenen, M., Merkus, P. J. F. M., de Vries, A. H. C., Hop, W. C. J., Warris, A., & Janssens, H. M. (2013). Diagnosis of invasive pulmonary aspergillosis in children with bronchoalveolar lavage galactomannan. Pediatric Pulmonology, 48(8), 789-796. https://doi.org/10.1002/ppul.22670