Comparison of an Aspergillus Real-time Polymerase Chain Reaction Assay with Galactomannan Testing of Bronchoalvelolar Lavage Fluid for the Diagnosis of Invasive Pulmonary Aspergillosis in Lung Transplant Recipients

作者：Luong Me Linh; Clancy Cornelius J; Vadnerkar Aniket; Kwak Eun Jeong; Silveira Fernanda P; Wissel Mark C; Grantham Kevin J; Shields Ryan K; Crespo Maria; Pilewski Joseph; Toyoda Yoshiya; Kleiboeker Steven B; Pakstis Diana; Reddy Sushruth K; Walsh Thomas J; Nguyen M Hong^*

来源：Clinical Infectious Diseases, 2011, 52(10): 1218-1226.

DOI：10.1093/cid/cir185

Background. Early diagnosis and treatment of invasive pulmonary aspergillosis (IPA) improves outcome.
Methods. We compared the performance of publicly available pan-Aspergillus, Aspergillus fumigatus-, and Aspergillus terreus-specific real-time polymerase chain reaction (PCR) assays with the Platelia galactomannan (GM) assay in 150 bronchoalveolar lavage (BAL) samples from lung transplant recipients (16 proven/probable IPA, 26 Aspergillus colonization, 11 non-Aspergillus mold colonization, and 97 negative controls).
Results. The sensitivity and specificity of pan-Aspergillus PCR (optimal quantification cycle [Cq], <= 35.0 by receiver operating characteristic analysis) and GM (>=.5) for diagnosing IPA were 100% (95% confidence interval, 79%-100%) and 88% (79%-92%), and 93% (68%-100%) and 89% (82%-93%), respectively. The sensitivity and specificity of A. fumigatus-specific PCR were 85% (55%-89%) and 96% (91%-98%), respectively. A. terreus-specific PCR was positive for the 1 patient with IPA due to this species; specificity was 99% (148 of 149 samples). Aspergillus PCR identified 1 patient with IPA not diagnosed by GM. For BAL samples associated with Aspergillus colonization, the specificity of GM (92%) was higher than that of pan-Aspergillus PCR (50%; P = .003). Among negative control samples, the specificity of pan-Aspergillus PCR (97%) was higher than that of BAL GM (88%; P = .03). Positive results for both BAL PCR and GM testing improved the specificity to 97% with minimal detriment to sensitivity (93%).
Conclusions. A recently developed pan-Aspergillus PCR assay and GM testing of BAL fluid may facilitate the diagnosis of IPA after lung transplantation. A. fumigatus- and A. terreus-specific real-time PCR assays may be useful in rapidly identifying the most common cause of IPA and a species that is intrinsically resistant to amphotericin B, respectively.

• 出版日期2011-5-15