Bronchoalveolar galactomannan in invasive pulmonary aspergillosis: A prospective study in pediatric patients

Abstract

Background: Elevations in the number of immunocompromised patients in the past decade has lead to progressive increase in the incidence of Invasive Pulmonary Aspergillosis (IPA) among children, however, early diagnosis remains a challenge. Detection of galactomannan (GM) in the bronchoalveolar lavage (BAL) fluid appears to possess higher sensitivity and specificity than serum in immunocompromised adult patients but, it rarely has been investigated in pediatric patients. Methods: We performed a prospective case-control study to evaluate the efficacy of BAL GM in immunocompromised pediatric patients. Cases were subjects fulfilling the host factor criteria as defined by the EORTC/MSG and met established definitions for proven or probable IPA. Control group was patients with possible IPA and patients without risk factors of IPA who underwent bronchoscopy for other diagnostic purpose. Galactomannan testing was performed on BAL fluid samples using Platelia Aspergillus seroassay. Results: Sixteen cases of IPA (4 proven, 12 probable), 16 possible IPA and 38 no IPA were documented according to EORTC/MSG definitions . The sensitivity, specificity, positive and negative predictive values of BAL GM using an OD index of ≥0.5 were 87.5%, 98.15%, 93.33% and 96.36% respectively. ROC analysis demonstrated an optimum OD index of 0.55 in our cohort. We found seven cases of IPA with negative serum GM while their BAL GM was positive. Conclusion: We found high diagnostic value of BAL GM in immunocompromised pediatric patients with IPA. The lower cut-off index is necessary in children to avoid missing the cases of IPA in children.