Use of Aspergillus fumigatus real-time PCR in bronchoalveolar lavage samples (BAL) for diagnosis of invasive aspergillosis, including azole-resistant cases, in high risk haematology patients: the need for a combined use with galactomannan.
Adult
Aged
Aged, 80 and over
Aspergillus fumigatus
/ isolation & purification
Blood Chemical Analysis
/ methods
Bronchoalveolar Lavage Fluid
/ microbiology
Female
Galactose
/ analogs & derivatives
Hematologic Neoplasms
/ complications
Humans
Invasive Pulmonary Aspergillosis
/ diagnosis
Male
Mannans
/ blood
Middle Aged
Molecular Diagnostic Techniques
/ methods
Real-Time Polymerase Chain Reaction
/ methods
Retrospective Studies
Sensitivity and Specificity
Time Factors
Young Adult
Aspergillus fumigatus PCR
BAL
HSCT
galactomannan
invasive aspergillosis
Journal
Medical mycology
ISSN: 1460-2709
Titre abrégé: Med Mycol
Pays: England
ID NLM: 9815835
Informations de publication
Date de publication:
01 Nov 2019
01 Nov 2019
Historique:
received:
10
10
2018
revised:
04
12
2018
accepted:
26
01
2019
pubmed:
13
2
2019
medline:
17
1
2020
entrez:
13
2
2019
Statut:
ppublish
Résumé
Diagnosis of invasive aspergillosis (IA) is challenging, particularly in high-risk patients with lung lesions other than typical according to 2008-EORTC/MSG criteria. Even if microbiology is positive, they still remain unclassified according to 2008-EORTC/MSG. Quantitative polymerase chain reaction (qPCR) provides new mycological documentation of IA. This retrospective study assessed Aspergillus fumigatus real time qPCR (MycoGENIE®) in BAL to diagnose IA and identify azole-resistant strains. Clinical, radiological, and microbiological data from 114 hematology patients (69% HSCT recipients; 29% on mould active agents) from years 2012-2017 were collected; and 123 BAL samples were tested with qPCR (cutoff: Ct < 40) and galactomannan (GM, Platelia®, cutoff: 0.5 ODI). Patients were classified as proven/probable, possible, and no-IA. "Atypical-IA" referred to patients with lesions other than typical according to 2008-EORTC/MSG and positive mycology. Proven IA was diagnosed in two cases (1.6%), probable in 28 (22.8%), possible in 27 (22%), atypical in 14 (11.4%). qPCR was positive in 39 samples (31.7%). Sensitivity and specificity of qPCR for proven/probable IA (vs no-IA; atypical-IA excluded) were 40% (95% confidence interval [CI]: 23-59) and 69% (95%CI: 55-81), respectively. Sensitivity of qPCR was higher when combined with GM (83%, 95%CI: 65-94) and in those receiving mould-active agents at BAL (61%, 95%CI: 32-86). One sample had TR34/L98H mutation. In conclusion, in high-risk hematology patients with various lung lesions, A. fumigatus qPCR in BAL contributes to diagnosing IA, particularly if combined with GM and in patients receiving mould-active agents might allow detecting azole-resistant mutations in culture negative samples.
Identifiants
pubmed: 30753590
pii: 5309017
doi: 10.1093/mmy/myz002
pmc: PMC7107636
doi:
Substances chimiques
Mannans
0
galactomannan
11078-30-1
Galactose
X2RN3Q8DNE
Types de publication
Evaluation Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
987-996Informations de copyright
© The Author(s) 2019. Published by Oxford University Press on behalf of The International Society for Human and Animal Mycology.
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