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

Research output: Contribution to journalArticle

22 Citations (Scopus)

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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Invasive Pulmonary Aspergillosis
Bronchoalveolar Lavage
Thorax
galactomannan
Sodium Glutamate
Bronchoalveolar Lavage Fluid
Immunocompromised Host
Bronchoscopy
Aspergillus
Secondary Prevention
Serum
Early Diagnosis
Therapeutics

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., ... 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

Diagnosis of invasive pulmonary aspergillosis in children with bronchoalveolar lavage galactomannan. / de Mol, Mark; de Jongste, Johan C; van Westreenen, Mireille; Merkus, Peter J. F. M.; de Vries, Andrica H. C.; Hop, Wim C. J.; Warris, Adilia; Janssens, Hettie M.

In: Pediatric Pulmonology, Vol. 48, No. 8, 08.2013, p. 789-796.

Research output: Contribution to journalArticle

de Mol, M, de Jongste, JC, van Westreenen, M, Merkus, PJFM, de Vries, AHC, Hop, WCJ, Warris, A & Janssens, HM 2013, 'Diagnosis of invasive pulmonary aspergillosis in children with bronchoalveolar lavage galactomannan', Pediatric Pulmonology, vol. 48, no. 8, pp. 789-796. https://doi.org/10.1002/ppul.22670
de Mol M, de Jongste JC, van Westreenen M, Merkus PJFM, de Vries AHC, Hop WCJ et al. Diagnosis of invasive pulmonary aspergillosis in children with bronchoalveolar lavage galactomannan. Pediatric Pulmonology. 2013 Aug;48(8):789-796. https://doi.org/10.1002/ppul.22670
de Mol, Mark ; de Jongste, Johan C ; van Westreenen, Mireille ; Merkus, Peter J. F. M. ; de Vries, Andrica H. C. ; Hop, Wim C. J. ; Warris, Adilia ; Janssens, Hettie M. / Diagnosis of invasive pulmonary aspergillosis in children with bronchoalveolar lavage galactomannan. In: Pediatric Pulmonology. 2013 ; Vol. 48, No. 8. pp. 789-796.
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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.",
keywords = "galactomannan, aspergillosis, bronchoalveolar lavage, children",
author = "{de Mol}, Mark and {de Jongste}, {Johan C} and {van Westreenen}, Mireille and Merkus, {Peter J. F. M.} and {de Vries}, {Andrica H. C.} and Hop, {Wim C. J.} and Adilia Warris and Janssens, {Hettie M.}",
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AU - de Mol, Mark

AU - de Jongste, Johan C

AU - van Westreenen, Mireille

AU - Merkus, Peter J. F. M.

AU - de Vries, Andrica H. C.

AU - Hop, Wim C. J.

AU - Warris, Adilia

AU - Janssens, Hettie M.

N1 - Funding source: none reported.

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N2 - 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.

AB - 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.

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