Abstract
Objectives: We evaluated the usefulness of an Aspergillus fumigatus quantitative PCR assay performed in bronchoalveolar lavage fluid (BAL) for the diagnosis and prognosis of both invasive and non-invasive aspergillosis.Methods: This 4-year retrospective study involved 613 at-risk patients who had either hematological disorders or other immunosuppressive conditions, notably solid organ transplants. Thirty-five patients had proven/probable aspergillosis and thirteen had chronic non-invasive aspergillosis. We compared PCR, galactomannan index and mycological analysis of BAL.Results: For invasive aspergillosis (IA), PCR performed in BAL yielded 88.6% sensitivity and 95.5% specificity. Comparatively, galactomannan index and mycological examination yielded only 56.3 and 63.6% sensitivity and 97.6 and 94.5% specificity, respectively. Considering the 13 chronic aspergillosis cases, PCR, galactomannan index and mycological examination yielded 76.9, 15.4, and 84.6% sensitivity and 92.2, 94.9, and 93% specificity, respectively. Fungal load in BAL evaluated by PCR was able to discriminate between aspergillosis and contamination, but not between invasive and non-invasive forms. Finally, fungal load was predictive of 90-day mortality, with 23.1% mortality for patients with less than 500 copies/mL versus 68.4% for patients above that cut-off (p < 0.05).Conclusion: Our results indicate that Aspergillus PCR in BAL is of particular interest for both the diagnosis and the prognosis of IA. It is likewise an interesting tool for the diagnosis of non-invasive forms.
Highlights
Invasive aspergillosis (IA) is a severe disease in immunocompromised patients
All patients in whom at least an Aspergillus polymerase chain reaction (PCR) was performed on bronchoalveolar lavage (BAL) due to a risk of IA or a suspicion of a noninvasive form of aspergillosis were included in the study
Diagnoses of proven or probable IA were made respectively for 2 and 33 patients according to the extended EORTC/MSG criteria including serum PCR as a mycological criterion, which was the only mycological criterion for 4 patients only
Summary
Invasive aspergillosis (IA) is a severe disease in immunocompromised patients. Not included in these criteria, the detection of Aspergillus DNA in blood samples by real-time polymerase chain reaction (PCR) has a long history of use and has been shown to be a very interesting test for diagnosing IA in both neutropenic and non-neutropenic patients (Suarez et al, 2008; Imbert et al, 2016). This approach has been shown to have predictive ability for disease outcome (Imbert et al, 2016). Some studies showed promising performances, less is known concerning its potential usefulness (Tuon, 2007; Zou et al, 2012; Grancini et al, 2018; Guegan et al, 2018)
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