Published ahead of print on September 20, 2007, doi:10.1164/rccm.200704-606OC Am. J. Respir. Crit. Care Med., Volume 177, Number 1, January 2008, 27-34 A more recent version of this article appeared on January 1, 2008
Submitted on April 20, 2007 Galactomannan in Broncho-alveolar Lavage Fluid: A Tool for Diagnosing Aspergillosis in ICU PatientsWouter Meersseman1*,1 Medical Intensive Care Unit and Infectious Diseases Unit, Department of General Internal Medicine, University Hospital, Leuven, Belgium, 2 Department of Medical Diagnostic Sciences, University Hospital, Leuven, Belgium, 3 Department of Hematology, University Hospital, Leuven, Belgium, 4 Department of Pharmacy, University Hospital, Leuven, Belgium, 5 Department of Pathology, University Hospital, Leuven, Belgium * To whom correspondence should be addressed. E-mail: wouter.meersseman{at}uz.kuleuven.ac.be.
Rationale: Invasive aspergillosis (IA) is an important cause of mortality in patients with hematological malignancies. However, IA appears to be gaining a foothold in the 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. Objective: This prospective, single center study, was conducted to investigate the role of GM in broncho-alveolar 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 CT 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 1109 admissions were eligible. There were 26 proven IA cases. Using a cut off index of 0.5, the sensitivity and specificity of GM detection in BAL fluid was 88% and 87%.The sensitivity of serum GM was only 42%. In 11 of 26 proven cases BAL culture and serum GM remained negative while GM in BAL was positive. Conclusions: Invasive aspergillosis is common in immunocompromised critically ill patients. Galactomannan detection in BAL fluid seems to be useful in establishing or excluding the diagnosis of invasive aspergillosis in ICU. Key words: Aspergillus; bronchoscopy; intensive care unit; galactomannan; immunosuppression
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