1. The utility of Galactomannan and Polymerase Chain Reaction Assays in Bronchoalveolar Lavage for diagnosis of Chronic Pulmonary Aspergillosis
- Author
-
MOHIT CHOWDHURY, Gagandeep Singh, Mragnayani Pandey, Himanshu Mishra, Ved prakash Meena, Prayas Sethi, Amandeep Singh, Bindu Prakash, Ashish datt upadhyay, Anant Mohan, Sanjeev Sinha, Immaculata Xess, Naveet Wig, Sushil Kumar Kabra, and Animesh Ray
- Abstract
The diagnosis of Chronic pulmonary aspergillosis (CPA) is established by combined clinic-radio-microbiological criteria. Out of the different microbiological criteria, usually a positive serology for Aspergillus-specific IgG levels is the cornerstone of diagnosis . Alternatively, other microbiological evidence can also be employed viz. significantly positive Aspergillus antigen (broncho-alveolar lavage fluid/BALF galactomannan ≥ 1.0), histopathological demonstration of the fungi following lung biopsy or resection, or demonstration of hyaline septate hyphae in direct microscopy resembling Aspergillus spp. or its growth on respiratory specimen. However the role of BALF- GM and the newer BALF-PCR have not been confirmed by studies till date. The study enrolled 210 patients overall of suspected CPA. Of the participants, 88 patients met the criteria for chronic pulmonary aspergillosis, whereas 122 patients had an alternative diagnosis. The sensitivity - specificity of AsperGenius® PCR and "in-house” PCR were 52.27(36.69-67.54) % - 33.78(23.19-45.72) % and 36.36(22.41-52.23) % - 39.19(28.04-51.23) % respectively. The sensitivity / specificity of BALF(>1.0) and serum galactomannan(>1.0) were 46.55%(33.34-60.13) / 64.08%(54.03-73.3) and 62.96%(54.7671.17) / 62.96%(54.76-71.17) respectively. The optimal cut-off value for BALF Galactomannan and serum galactomannan in diagnosing CPA was found to be 0.69 (sensitivity: 64%; specificity: 53%) and 0.458 (sensitivity: 67%; specificity: 64%) respectively. Aspergillus PCR from BAL may not be a good “rule-in” test for diagnosing CPA. While the performances of GM in BAL and serum may be better than PCR, it is to be used in conjunction with other clinical, radiological and other microbiological characteristics.
- Published
- 2023