Evaluation of Galactomannan Testing, the Aspergillus-Specific Lateral-Flow Device Test and Levels of Cytokines in Bronchoalveolar Lavage Fluid for Diagnosis of Chronic Pulmonary Aspergillosis
Open accessAbstract
Background: Diagnosis of chronic pulmonary aspergillosis (CPA) is challenging. Symptoms are unspecific or missing, radiological findings are variable and proof of mycological evidence is limited by the accuracy of diagnostic tests. The goal of this study was to investigate diagnostic performance of galactomannan (GM), the newly formatted Aspergillus-specific lateral-flow-device test (LFD), and a number of cytokines in bronchoalveolar lavage fluid (BALF) samples obtained from patients with CPA, patients with respiratory disorders without CPA and healthy individuals. Methods: Patients with CPA (n=27) and controls (n=27 with underlying respiratory diseases but without CPA, and n=27 healthy volunteers) were recruited at the Medical University of Graz, Austria and the Research Center Borstel, Germany between 2010 and 2018. GM, LFD and cytokine testing was performed retrospectively at the Research Center Borstel. Results: Sensitivity and specificity of GM testing from BALF with a cut off level of ≥0.5 optical density index (ODI) was 41% and 100% and 30% and 100% with a cut off level of ≥1.0 ODI. ROC curve analysis showed an AUC 0.718 (95% CI 0.581 – 0.855) for GM for differentiating CPA patients to patients with other respiratory diseases without CPA. The LFD resulted positive in only 3 patients with CPA (7%) and was highly specific. CPA patients did not differ significantly in the BALF cytokine profile compared to patients with respiratory disorders without CPA, but showed significant higher values for IFN-γ, IL-1b, IL-6, IL-8 and TNF-α compared to healthy individuals. Conclusion: Both GM and LFD showed insufficient performance for diagnosing CPA, with sensitivities of BALF GM below 50%, and sensitivity of the LFD below 10%. The high specificities may however result in a high positive predictive value and thereby help to identify semi-invasive or invasive disease.
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Recent studies showed that BAL fluid GM has improved sensitivity compared to serum GM in high-risk patients with IPA, including nonneutropenic patients.
“Recent studies showed that BAL fluid GM has improved sensitivity compared to serum GM in high-risk patients with IPA, including nonneutropenic patients (88, 114–119).”
From Aspergillus fumigatus and Aspergillosis in 2019 (2019) · cites this paper as [117]
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References 21 · Cited by 41
Research works printed but not linked: 1
- Haussinger K. Ballin A. Becker H. D. Bolcskei P. Dierkesmann R. Dittrich I. (2004). Recommendations for quality standards in bronchoscopy. Pneumologie 58 344– 356. 15162262
- Authors
- Salzer, H. J. F., Prattes, J., Flick, H., Reimann, M., Heyckendorf, J., Kalsdorf, B., Obersteiner, S., Gaede, K. I., Herzmann, C., Johnson, G. L., Lange, C., & Hoenigl, M.
- Affiliations
- German Center for Infection Research (DE)
- Medical University of Graz (AT)
- Karolinska Institutet (SE)
- Corresponding author
- Salzer, Helmut J. F.
- Prattes, Juergen
- ORCID
- Venue
- Frontiers in Microbiology
- Publisher
- Frontiers Media SA
- Published
- 2018-10-02
- Volume
- 9
- Pages
- 2223-2223
- ISSN
- 1664-302X (ISSN-L)
- PMC
- PMC6176022
- OpenAlex
- W2894767974
- Cited by
- 41
- References
- 21
- Citations by year
- 2026: 8 · 2025: 3 · 2024: 5 · 2023: 8 · 2022: 1 · 2021: 6 · 2020: 4 · 2019: 5 · 2018: 1
- FWCI
- 3.02
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Frontiers in Microbiology (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- eScholarship (California Digital Library) (submittedVersion)
- eScholarship (California Digital Library) (submittedVersion, cc-by)
- Topics
- Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
- Health Sciences › Medicine › Epidemiology › Fungal Infections and Studies
- Health Sciences › Medicine › Physiology › Asthma and respiratory diseases
- Keywords
- chronic pulmonary aspergillosis, galactomannan, lateral flow devices, bronchoalveolar lavage fluid, cytokines, sensitivity and specificity, interferon-gamma, interleukin-6, interleukin-8, TNF-α, IL-1β, invasive aspergillosis
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