Abstract
In recent years, various biomarkers have been gradually applied on bronchoalveolar lavage (BAL) fluid for the diagnosis of invasive pulmonary aspergillosis (IPA). The objective of this study is to assess the value of the liquid-based cytopathology test (LCT) for improving the identification of IPA in BAL fluid from possible IPA patients, following special staining with periodic acid-Schiff staining (PAS) or Grocott's methenamine silver (GMS). A total of 47 consecutive possible IPA patients who underwent bronchoscopy with BAL fluid from January 2017 to December 2018 were included. 45 people had a pair of BAL fluid specimens and 2 patients had two BAL fluid specimens. The 49 pairs of BAL fluid specimens were processed for culture, tuberculosis acid fast staining smear, direct microbial smear, and LCT with special staining (PAS and GMS), respectively. Then, we compared the sensitivity and specificity of PAS and GMS in BAL fluid in high-risk patients. Among 47 possible IPA patients, 25 patients had proven/probable IPA, and 11 patients had other invasive fungal diseases. The sensitivity of GMS was higher than that of PAS (92.11% versus 81.58%; P = 0.175). The specificity of GMS was 81.82%, which was higher than that of PAS (81.82% versus 72.73%; P = 0.611). The negative predictive value (NPV) for PAS and GMS were 53.33% and 75.00%, respectively. The positive predictive value (PPV) for PAS and GMS were 91.18% and 94.59%, respectively. This study showed that special staining of LCT in BAL fluid may be a novel method for the diagnosis of IPA, and the GMS of LCT had higher sensitivity and specificity, which was superior to PAS.
Highlights
Invasive pulmonary aspergillosis (IPA) remains a lifethreatening disease caused by aspergillus
No history of AIDS, Talaromyces marneffei was cultured positive in bronchoalveolar lavage (BAL) fluid, and the mass spectrometer indicated that the patient was positive for Talaromyces marneffei. 11 patients were diagnosed as having nonfungal diseases, including 3 community acquired pneumonia (CAP), 1 bronchiectasis, 1 lung abscess, 2 tuberculosis and 4 noninfectious disease cases
A total of 47 possible IPA patients were enrolled in our study, duplicate 49 pairs BAL fluid specimens were collected from 47 patients, with 45 people having a pair of BAL fluid specimens and 2 patients having two pairs of BAL fluid specimens (Figure 1)
Summary
Invasive pulmonary aspergillosis (IPA) remains a lifethreatening disease caused by aspergillus. Air-borne infections caused by Pneumocystis jirovecii and Aspergillus spp. are frequent. Microbiological diagnosis of P. jirovecii infection is commonly based on microscopic detection of cysts and trophic forms [7], so aspergillus spores should be distinguished from Pneumocystis jirovecii, cryptococcus spores, and other fungal spores. Mucormycosis and IPA patients have similar underlying diseases, risk factors, clinical manifestations, and radiological signs [8], and the mycelium morphology of Canadian Respiratory Journal mucormycosis is similar to that of aspergillus, so it is easy to mistake mucormycosis for aspergillus. Owing to the nonspecific clinical manifestations, low sensitivity, and specificity of microbiological tests, diagnosing IPA remains a challenge [1, 2, 4]. Owing to the nonspecific clinical manifestations, low sensitivity, and specificity of microbiological tests, diagnosing IPA remains a challenge [1, 2, 4]. ere is a definite need for a newer method for diagnosis of IPA
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