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
| Autor: | Elena De Carolis, Maria Lucia Borghesi, Enrico Drago, Emanuela Zappulo, Maurizio Sanguinetti, Carmen Di Grazia, Elisa Furfaro, Giuseppe Cittadini, Claudio Viscoli, Emanuele Angelucci, Malgorzata Mikulska, Anna Maria Raiola, Valerio Del Bono, Ilaria Pulzato |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
Male
Time Factors medicine.medical_treatment Hematopoietic stem cell transplantation Aspergillosis Gastroenterology Aspergillus fumigatus Mannans chemistry.chemical_compound Aged 80 and over Invasive Pulmonary Aspergillosis 0303 health sciences Hematology biology medicine.diagnostic_test General Medicine Middle Aged Infectious Diseases Real-time polymerase chain reaction Molecular Diagnostic Techniques Hematologic Neoplasms HSCT Original Article Female Bronchoalveolar Lavage Fluid Adult medicine.medical_specialty Real-Time Polymerase Chain Reaction Sensitivity and Specificity 03 medical and health sciences Galactomannan Young Adult Internal medicine medicine Humans Aspergillus fumigatus PCR 030304 developmental biology Aged Retrospective Studies BAL Aspergillus invasive aspergillosis 030306 microbiology business.industry Galactose biology.organism_classification medicine.disease Bronchoalveolar lavage chemistry galactomannan business Blood Chemical Analysis |
| Zdroj: | Medical Mycology |
| ISSN: | 1460-2709 1369-3786 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|