This Article Full Text Full Text (PDF) Online Supplement All Versions of this Article: 200704-606OCv1 177/1/27    most recent Alert me when this article is cited Alert me if a correction is posted Services Related articles in AJRCCM Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Meersseman, W. Articles by Van Wijngaerden, E. Search for Related Content PubMed PubMed Citation Articles by Meersseman, W. Articles by Van Wijngaerden, E.

Galactomannan in Bronchoalveolar Lavage Fluid

A Tool for Diagnosing Aspergillosis in Intensive Care Unit Patients

¹ Medical Intensive Care Unit and Infectious Diseases Unit, Department of General Internal Medicine; ² Department of Medical Diagnostic Sciences; ³ Department of Hematology, ⁴ Department of Pharmacy; and ⁵ Department of Pathology, University Hospital Leuven, Leuven, Belgium

Correspondence and requests for reprints should be addressed to Wouter Meersseman, M.D., Medical Intensive Care Unit, University Hospital Leuven, Herestraat 49, B-3000 Leuven, Belgium. E-mail: wouter.meersseman{at}uz.kuleuven.ac.be

Rationale: Invasive aspergillosis (IA) is an important cause of mortality in patients with hematologic malignancies. However, IA appears to be gaining a foothold in the intensive care unit (ICU) in patients without classical risk factors. A recent study described 89 cases of IA in patients in a medical ICU without leukemia or cancer. The diagnosis of IA remains difficult and is often established too late. Galactomannan (GM) is an exo-antigen released from Aspergillus hyphae while they invade host tissue.

Objectives: This prospective single-center study was conducted to investigate the role of GM in bronchoalveolar lavage (BAL) fluid as a tool for early diagnosis of IA in the ICU.

Methods: All patients with risk factors identified in our earlier study were evaluated. BAL for culture and GM detection, serum GM levels, and computed tomography scan were obtained for all included patients with signs of pneumonia. Patients were classified as having proven, probable, or possible IA.

Measurements and Main Results: A total of 110 patients out of 1,109 admissions were eligible. There were 26 proven IA cases. Using a cutoff index of 0.5, the sensitivity and specificity of GM detection in BAL fluid was 88 and 87%, respectively. The sensitivity of serum GM was only 42%. In 11 of 26 proven cases, BAL culture and serum GM remained negative, whereas GM in BAL was positive.

Conclusions: IA is common in immunocompromised, critically ill patients. GM detection in BAL fluid seems to be useful in establishing or excluding the diagnosis of IA in the ICU.

Key Words: Aspergillus • bronchoscopy • intensive care unit • galactomannan • immunosuppression

AT A GLANCE COMMENTARY Scientific Knowledge on the Subject Aspergillosis is an increasingly recognized problem in ICU patients, but diagnosis remains challenging. What This Study Adds to the Field The use of galactomannan in bronchoalveolar lavage fluid as a means of establishing early diagnosis of invasive aspergillosis in critically ill patients at risk is promising.

 

Related articles in AJRCCM:

A Bad Bug Takes on a New Role as a Cause of Ventilator-associated Pneumonia

Elias J. Anaissie
AJRCCM 2008 177: 1-2. [Full Text]  

This article has been cited by other articles:

				R. A. Fowler, N. K. J. Adhikari, D. C. Scales, W. L. Lee, and G. D. Rubenfeld Update in Critical Care 2008 Am. J. Respir. Crit. Care Med., May 1, 2009; 179(9): 743 - 758. [Full Text] [PDF]

				B. H. Segal Aspergillosis N. Engl. J. Med., April 30, 2009; 360(18): 1870 - 1884. [Full Text] [PDF]

				J. L. Werner, A. E. Metz, D. Horn, T. R. Schoeb, M. M. Hewitt, L. M. Schwiebert, I. Faro-Trindade, G. D. Brown, and C. Steele Requisite Role for the Dectin-1 {beta}-Glucan Receptor in Pulmonary Defense against Aspergillus fumigatus J. Immunol., April 15, 2009; 182(8): 4938 - 4946. [Abstract] [Full Text] [PDF]

				K. L. Lawrence and M. H. Kollef Antimicrobial Stewardship in the Intensive Care Unit: Advances and Obstacles Am. J. Respir. Crit. Care Med., March 15, 2009; 179(6): 434 - 438. [Abstract] [Full Text] [PDF]

				S. Husain, C. J. Clancy, M. H. Nguyen, S. Swartzentruber, H. Leather, A. M. LeMonte, M. M. Durkin, K. S. Knox, C. A. Hage, C. Bentsen, et al. Performance Characteristics of the Platelia Aspergillus Enzyme Immunoassay for Detection of Aspergillus Galactomannan Antigen in Bronchoalveolar Lavage Fluid Clin. Vaccine Immunol., December 1, 2008; 15(12): 1760 - 1763. [Abstract] [Full Text] [PDF]

				W. A. Wuyts, M. Thomeer, L. J. Dupont, and G. M. Verleden An Algorithm to Tackle Acute Exacerbations in Idiopathic Pulmonary Fibrosis Am. J. Respir. Crit. Care Med., June 15, 2008; 177(12): 1397 - 1397. [Full Text] [PDF]

				Diagnosing Invasive Aspergillosis in ICU Patients Journal Watch Infectious Diseases, January 16, 2008; 2008(116): 2 - 2. [Full Text]

				E. J. Anaissie A Bad Bug Takes on a New Role as a Cause of Ventilator-associated Pneumonia Am. J. Respir. Crit. Care Med., January 1, 2008; 177(1): 1 - 2. [Full Text] [PDF]