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Journal of Clinical Microbiology, June 2007, p. 1759-1765, Vol. 45, No. 6
0095-1137/07/$08.00+0     doi:10.1128/JCM.00077-07
Copyright © 2007, American Society for Microbiology. All Rights Reserved.

Bronchoalveolar Lavage Galactomannan in Diagnosis of Invasive Pulmonary Aspergillosis among Solid-Organ Transplant Recipients

Department of Medicine, University of Florida College of Medicine, Gainesville, Florida,¹ North Florida/South Georgia Veterans Health System, Gainesville, Florida,² Shands Teaching Hospital Department of Pharmacy, Gainesville, Florida,³ MiraVista Diagnostics, Indianapolis, Indiana⁴

Received 10 January 2007/ Returned for modification 14 March 2007/ Accepted 2 April 2007

We review the experience at our institution with galactomannan (GM) testing of bronchoalveolar lavage (BAL) fluid in the diagnosis of invasive pulmonary aspergillosis (IPA) among solid-organ transplant recipients. Among 81 patients for whom BAL GM testing was ordered (heart, 24; kidney, 22; liver, 19; lung, 16), there were five cases of proven or probable IPA. All five patients had BAL GM of 2.1 and survived following antifungal therapy. The sensitivity, specificity, and positive and negative predictive values for BAL GM testing at a cutoff of 1.0 were 100%, 90.8%, 41.7%, and 100%, respectively. The sensitivity of BAL GM testing was better than that of conventional tests such as serum GM or BAL cytology and culture. Moreover, a positive BAL GM test diagnosed IPA several days to 4 weeks before other methods for three patients. Twelve patients had BAL GM of 0.5 but no evidence of IPA. Among these, lung transplant recipients accounted for 41.7% (5/12) of the false-positive results, reflecting frequent colonization of airways in this population. Excluding lung transplants, the specificity and positive predictive value for other solid-organ transplants increased to 92.9% and 62.5%, respectively (cutoff, 1.0). In conclusion, BAL GM testing facilitated more-rapid diagnoses of IPA and the institution of antifungal therapy among non-lung solid-organ transplant recipients and helped to rule out IPA.

Published ahead of print on 11 April 2007.

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