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Journal of Clinical Microbiology, September 2007, p. 2787-2792, Vol. 45, No. 9
0095-1137/07/$08.00+0     doi:10.1128/JCM.00716-07
Copyright © 2007, American Society for Microbiology. All Rights Reserved.

Use of Bronchoalveolar Lavage To Detect Galactomannan for Diagnosis of Pulmonary Aspergillosis among Nonimmunocompromised Hosts{triangledown}

M. Hong Nguyen,1,2 Reia Jaber,1 Helen L. Leather,3 John R. Wingard,1 Benjamin Staley,3 L. Joseph Wheat,4 Christina L. Cline,1 Maher Baz,1 Kenneth H. Rand,1 and Cornelius J. Clancy1,2*

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 2 April 2007/ Returned for modification 22 May 2007/ Accepted 14 June 2007

Pulmonary aspergillosis in nonimmunocompromised hosts, although rare, is being increasingly recognized. The diagnosis of pulmonary aspergillosis is difficult, since the recovery of Aspergillus from respiratory samples cannot differentiate colonization from invasion. We assessed the role of bronchoalveolar lavage (BAL) in detecting galactomannan (GM) for diagnosing pulmonary aspergillosis in 73 nonimmunocompromised patients with pulmonary infiltrates for whom the test was ordered. Six patients had pulmonary aspergillosis, two each with acute invasive pulmonary aspergillosis, chronic necrotizing pulmonary aspergillosis, and aspergilloma. All six patients had a BAL GM level of ≥1.18. The sensitivity, specificity, and negative predictive value (NPV) for a BAL GM level of ≥1.0 were 100%, 88.1%, and 100%, respectively. Notably, the positive predictive value (PPV) was only 42.9%, likely reflecting the low prevalence of pulmonary aspergillosis among nonimmunosuppressed patients. The combination of BAL microscopy and culture had a sensitivity and NPV similar to those of BAL GM detection but a higher specificity and PPV (92.5% and 54.6%, respectively). Moreover, a BAL GM test did not identify any cases that were not diagnosed by conventional methods like microscopy and culture. In conclusion, there was no conclusive benefit of determining BAL GM levels in the diagnosis of pulmonary aspergillosis among nonimmunocompromised hosts. Given the likelihood of false-positive results, a BAL GM test should not be ordered routinely in this population.

* Corresponding author. Mailing address: University of Florida College of Medicine, Box 100277 JHMHC, Gainesville, FL 32610. Phone: (352) 379-4027. Fax: (352) 379-4015. E-mail: clancyn{at}medicine.ufl.edu

{triangledown} Published ahead of print on 27 June 2007.

Journal of Clinical Microbiology, September 2007, p. 2787-2792, Vol. 45, No. 9
0095-1137/07/$08.00+0     doi:10.1128/JCM.00716-07
Copyright © 2007, American Society for Microbiology. All Rights Reserved.





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