Diagnosis of invasive pulmonary aspergillosis in children with bronchoalveolar lavage galactomannan

• Published in: Pediatric pulmonology 2013-08, Vol.48 (8), p.789-796
• Main Authors: 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.
• Format: Article
• Language: English
• Subjects: Adolescent; aspergillosis; Aspergillus - isolation & purification; bronchoalveolar lavage; Bronchoalveolar Lavage - methods; Bronchoalveolar Lavage Fluid - microbiology; Bronchoscopy; Child; Child, Preschool; children; Diagnosis, Differential; Early Diagnosis; Female; Follow-Up Studies; galactomannan; Humans; Infant; Invasive Pulmonary Aspergillosis - diagnosis; Invasive Pulmonary Aspergillosis - microbiology; Male; Mannans; Reproducibility of Results; Retrospective Studies
• ISSN: 8755-6863; 1099-0496
• DOI: 10.1002/ppul.22670

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. Pediatr Pulmonol. 2013; 48:789–796. © 2012 Wiley Periodicals, Inc.