1887

Abstract

. Evidence for the clinical utility of bronchoalveolar lavage (BAL) galactomannan in the management of fungal disease outside of haemato-oncology patients is limited.

. To determine how the introduction of BAL galactomannan testing impacted on the diagnosis and management of invasive aspergillosis and other fungal diseases in non-haemato-oncology patients.

. Retrospective review of all adult patients (age ≥16 years) without a diagnosis of haematological malignancy who had a positive BAL galactomannan from 1 November 2014 to 30 April 2018. Using electronic patient records we obtained demographic data, clinical details, laboratory investigations, relevant radiology and antimicrobial history for each case.

. In total, 121 episodes with a galactomannan OD index of ≥0.500 were included in the study; 29 cases (24 %) were felt to reflect fungal disease. Antifungal therapy was commenced as a direct consequence of a positive BAL galactomannan result in 13 patients where the ultimate diagnosis was subsequently considered to be non-mycological: associated medication-related side-effects in this group included deranged liver function tests (=3), rash (=1) and fever (=1), related to amphotericin B (=1) and voriconazole (=4).

. We show that vigilance is required when interpreting galactomannan results in non-haematology patients to avoid potentially harmful overtreatment.

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2019-11-20
2024-04-25
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References

  1. Enoch DA, Yang H, Aliyu SH, Micallef C. The Changing Epidemiology of Invasive Fungal Infections. Methods in Molecular Biology Clifton, NJ: 2017 pp 17–65
    [Google Scholar]
  2. Denning D. Early diagnosis of invasive aspergillosis. The Lancet 2000; 355:423–424 [View Article]
    [Google Scholar]
  3. Sherif R, Segal BH. Pulmonary aspergillosis: clinical presentation, diagnostic tests, management and complications. Curr Opin Pulm Med 2010; 16:1 [View Article]
    [Google Scholar]
  4. Leeflang MM, Debets-Ossenkopp YJ, Visser CE, Scholten RJ, Hooft L. Galactomannan detection for invasive aspergillosis in immunocompromized patients. In Leeflang MM. editor Cochrane Database of Systematic Reviews Chichester, UK: John Wiley & Sons, Ltd;; 2008
    [Google Scholar]
  5. Zou M, Tang L, Zhao S, Zhao Z, Chen L et al. Systematic review and meta-analysis of detecting galactomannan in bronchoalveolar lavage fluid for diagnosing invasive aspergillosis. PLoS One 2012; 7:e43347 [View Article]
    [Google Scholar]
  6. Baddley JW. Clinical risk factors for invasive aspergillosis. Med Mycol 2011; 49:S7–S12 [View Article]
    [Google Scholar]
  7. Lin PC, Lai QQ, Zhou Y, Ye JR, Wu Q et al. [The diagnostic performance of galactomannan detection for invasive pulmonary aspergillosis in non-neutropenic hosts]. Zhonghua Jie He He Hu Xi Za Zhi 2016; 39:929–933 [View Article]
    [Google Scholar]
  8. Zhuang Q, Ma H, Zhang Y, Chen L, Wang L et al. Galactomannan in bronchoalveolar lavage fluid for diagnosis of invasive pulmonary aspergillosis with nonneutropenic patients. Can Respir J 2017; 2017:1–7 [View Article]
    [Google Scholar]
  9. Micallef C, Aliyu SH, Santos R, Brown NM, Rosembert D et al. Introduction of an antifungal stewardship programme targeting high-cost antifungals at a tertiary hospital in Cambridge, England. J Antimicrob Chemother 2015; 70:1908–1911 [View Article]
    [Google Scholar]
  10. De Pauw B, Walsh TJ, Donnelly JP, Stevens DA, Edwards JE et al. Revised definitions of invasive fungal disease from the European organization for research and treatment of Cancer/Invasive fungal infections cooperative group and the National Institute of allergy and infectious diseases Mycoses Study Group (EORTC/MSG) consensus group. Clin Infect Dis 2008; 46:1813–1821 [View Article]
    [Google Scholar]
  11. Denning DW, Cadranel J, Beigelman-Aubry C, Ader F, Chakrabarti A et al. Chronic pulmonary aspergillosis: rationale and clinical guidelines for diagnosis and management. Eur Respir J 2016; 47:45–68 [View Article]
    [Google Scholar]
  12. Verweij PE, Latgé JP, Rijs AJ, Melchers WJ, De Pauw BE et al. Comparison of antigen detection and PCR assay using bronchoalveolar lavage fluid for diagnosing invasive pulmonary aspergillosis in patients receiving treatment for hematological malignancies. J Clin Microbiol 1995; 33:3150–3153
    [Google Scholar]
  13. Singh N, Paterson DL. Aspergillus infections in transplant recipients. Clin Microbiol Rev 2005; 18:44–69 [View Article]
    [Google Scholar]
  14. Ansorg R, van den Boom R, Rath PM. Detection of Aspergillus galactomannan antigen in foods and antibiotics. Mycoses 1997; 40:353–357 [View Article]
    [Google Scholar]
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