Comparison of an aspergillus real-time polymerase chain reaction assay with galactomannan testing of bronchoalvelolar lavage fluid for the diagnosis of invasive pulmonary aspergillosis in lung transplant recipients

Me Linh Luong, Cornelius J. Clancy, Aniket Vadnerkar, Eun Jeong Kwak, Fernanda P. Silveira, Mark C. Wissel, Kevin J. Grantham, Ryan K. Shields, Maria Crespo, Joseph Pilewski, Yoshiya Toyoda, Steven B. Kleiboeker, Diana Pakstis, Sushruth K. Reddy, Thomas J. Walsh, M. Hong Nguyen

Research output: Contribution to journalArticle

Abstract

Background. Early diagnosis and treatment of invasive pulmonary aspergillosis (IPA) improves outcome. Methods. We compared the performance of publicly available pan-Aspergillus, Aspergillus fumigatus-, and Aspergillus terreus-specific real-time polymerase chain reaction (PCR) assays with the Platelia galactomannan (GM) assay in 150 bronchoalveolar lavage (BAL) samples from lung transplant recipients (16 proven/probable IPA, 26 Aspergillus colonization, 11 non-Aspergillus mold colonization, and 97 negative controls). Results. The sensitivity and specificity of pan-Aspergillus PCR (optimal quantification cycle [Cq], ≤35.0 by receiver operating characteristic analysis) and GM (≥.5) for diagnosing IPA were 100% (95% confidence interval, 79%-100%) and 88% (79%-92%), and 93% (68%-100%) and 89% (82%-93%), respectively. The sensitivity and specificity of A. fumigatus-specific PCR were 85% (55%-89%) and 96% (91%-98%), respectively. A. terreus-specific PCR was positive for the 1 patient with IPA due to this species; specificity was 99% (148 of 149 samples). Aspergillus PCR identified 1 patient with IPA not diagnosed by GM. For BAL samples associated with Aspergillus colonization, the specificity of GM (92%) was higher than that of pan-Aspergillus PCR (50%; P =. 003). Among negative control samples, the specificity of pan-Aspergillus PCR (97%) was higher than that of BAL GM (88%; P =. 03). Positive results for both BAL PCR and GM testing improved the specificity to 97% with minimal detriment to sensitivity (93%). Conclusions. A recently developed pan-Aspergillus PCR assay and GM testing of BAL fluid may facilitate the diagnosis of IPA after lung transplantation. A. fumigatus- and A. terreus-specific real-time PCR assays may be useful in rapidly identifying the most common cause of IPA and a species that is intrinsically resistant to amphotericin B, respectively.

Original languageEnglish (US)
Pages (from-to)1218-1226
Number of pages9
JournalClinical Infectious Diseases
Volume52
Issue number10
DOIs
StatePublished - May 15 2011
Externally publishedYes

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Invasive Pulmonary Aspergillosis
Therapeutic Irrigation
Aspergillus
Real-Time Polymerase Chain Reaction
Lung
Polymerase Chain Reaction
Bronchoalveolar Lavage
Aspergillus fumigatus
galactomannan
Transplant Recipients
Sensitivity and Specificity
Lung Transplantation
Bronchoalveolar Lavage Fluid
Amphotericin B
ROC Curve
Early Diagnosis
Fungi
Confidence Intervals

ASJC Scopus subject areas

  • Infectious Diseases
  • Microbiology (medical)

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Comparison of an aspergillus real-time polymerase chain reaction assay with galactomannan testing of bronchoalvelolar lavage fluid for the diagnosis of invasive pulmonary aspergillosis in lung transplant recipients. / Luong, Me Linh; Clancy, Cornelius J.; Vadnerkar, Aniket; Kwak, Eun Jeong; Silveira, Fernanda P.; Wissel, Mark C.; Grantham, Kevin J.; Shields, Ryan K.; Crespo, Maria; Pilewski, Joseph; Toyoda, Yoshiya; Kleiboeker, Steven B.; Pakstis, Diana; Reddy, Sushruth K.; Walsh, Thomas J.; Nguyen, M. Hong.

In: Clinical Infectious Diseases, Vol. 52, No. 10, 15.05.2011, p. 1218-1226.

Research output: Contribution to journalArticle

Luong, ML, Clancy, CJ, Vadnerkar, A, Kwak, EJ, Silveira, FP, Wissel, MC, Grantham, KJ, Shields, RK, Crespo, M, Pilewski, J, Toyoda, Y, Kleiboeker, SB, Pakstis, D, Reddy, SK, Walsh, TJ & Nguyen, MH 2011, 'Comparison of an aspergillus real-time polymerase chain reaction assay with galactomannan testing of bronchoalvelolar lavage fluid for the diagnosis of invasive pulmonary aspergillosis in lung transplant recipients', Clinical Infectious Diseases, vol. 52, no. 10, pp. 1218-1226. https://doi.org/10.1093/cid/cir185
Luong, Me Linh ; Clancy, Cornelius J. ; Vadnerkar, Aniket ; Kwak, Eun Jeong ; Silveira, Fernanda P. ; Wissel, Mark C. ; Grantham, Kevin J. ; Shields, Ryan K. ; Crespo, Maria ; Pilewski, Joseph ; Toyoda, Yoshiya ; Kleiboeker, Steven B. ; Pakstis, Diana ; Reddy, Sushruth K. ; Walsh, Thomas J. ; Nguyen, M. Hong. / Comparison of an aspergillus real-time polymerase chain reaction assay with galactomannan testing of bronchoalvelolar lavage fluid for the diagnosis of invasive pulmonary aspergillosis in lung transplant recipients. In: Clinical Infectious Diseases. 2011 ; Vol. 52, No. 10. pp. 1218-1226.
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abstract = "Background. Early diagnosis and treatment of invasive pulmonary aspergillosis (IPA) improves outcome. Methods. We compared the performance of publicly available pan-Aspergillus, Aspergillus fumigatus-, and Aspergillus terreus-specific real-time polymerase chain reaction (PCR) assays with the Platelia galactomannan (GM) assay in 150 bronchoalveolar lavage (BAL) samples from lung transplant recipients (16 proven/probable IPA, 26 Aspergillus colonization, 11 non-Aspergillus mold colonization, and 97 negative controls). Results. The sensitivity and specificity of pan-Aspergillus PCR (optimal quantification cycle [Cq], ≤35.0 by receiver operating characteristic analysis) and GM (≥.5) for diagnosing IPA were 100{\%} (95{\%} confidence interval, 79{\%}-100{\%}) and 88{\%} (79{\%}-92{\%}), and 93{\%} (68{\%}-100{\%}) and 89{\%} (82{\%}-93{\%}), respectively. The sensitivity and specificity of A. fumigatus-specific PCR were 85{\%} (55{\%}-89{\%}) and 96{\%} (91{\%}-98{\%}), respectively. A. terreus-specific PCR was positive for the 1 patient with IPA due to this species; specificity was 99{\%} (148 of 149 samples). Aspergillus PCR identified 1 patient with IPA not diagnosed by GM. For BAL samples associated with Aspergillus colonization, the specificity of GM (92{\%}) was higher than that of pan-Aspergillus PCR (50{\%}; P =. 003). Among negative control samples, the specificity of pan-Aspergillus PCR (97{\%}) was higher than that of BAL GM (88{\%}; P =. 03). Positive results for both BAL PCR and GM testing improved the specificity to 97{\%} with minimal detriment to sensitivity (93{\%}). Conclusions. A recently developed pan-Aspergillus PCR assay and GM testing of BAL fluid may facilitate the diagnosis of IPA after lung transplantation. A. fumigatus- and A. terreus-specific real-time PCR assays may be useful in rapidly identifying the most common cause of IPA and a species that is intrinsically resistant to amphotericin B, respectively.",
author = "Luong, {Me Linh} and Clancy, {Cornelius J.} and Aniket Vadnerkar and Kwak, {Eun Jeong} and Silveira, {Fernanda P.} and Wissel, {Mark C.} and Grantham, {Kevin J.} and Shields, {Ryan K.} and Maria Crespo and Joseph Pilewski and Yoshiya Toyoda and Kleiboeker, {Steven B.} and Diana Pakstis and Reddy, {Sushruth K.} and Walsh, {Thomas J.} and Nguyen, {M. Hong}",
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T1 - Comparison of an aspergillus real-time polymerase chain reaction assay with galactomannan testing of bronchoalvelolar lavage fluid for the diagnosis of invasive pulmonary aspergillosis in lung transplant recipients

AU - Luong, Me Linh

AU - Clancy, Cornelius J.

AU - Vadnerkar, Aniket

AU - Kwak, Eun Jeong

AU - Silveira, Fernanda P.

AU - Wissel, Mark C.

AU - Grantham, Kevin J.

AU - Shields, Ryan K.

AU - Crespo, Maria

AU - Pilewski, Joseph

AU - Toyoda, Yoshiya

AU - Kleiboeker, Steven B.

AU - Pakstis, Diana

AU - Reddy, Sushruth K.

AU - Walsh, Thomas J.

AU - Nguyen, M. Hong

PY - 2011/5/15

Y1 - 2011/5/15

N2 - Background. Early diagnosis and treatment of invasive pulmonary aspergillosis (IPA) improves outcome. Methods. We compared the performance of publicly available pan-Aspergillus, Aspergillus fumigatus-, and Aspergillus terreus-specific real-time polymerase chain reaction (PCR) assays with the Platelia galactomannan (GM) assay in 150 bronchoalveolar lavage (BAL) samples from lung transplant recipients (16 proven/probable IPA, 26 Aspergillus colonization, 11 non-Aspergillus mold colonization, and 97 negative controls). Results. The sensitivity and specificity of pan-Aspergillus PCR (optimal quantification cycle [Cq], ≤35.0 by receiver operating characteristic analysis) and GM (≥.5) for diagnosing IPA were 100% (95% confidence interval, 79%-100%) and 88% (79%-92%), and 93% (68%-100%) and 89% (82%-93%), respectively. The sensitivity and specificity of A. fumigatus-specific PCR were 85% (55%-89%) and 96% (91%-98%), respectively. A. terreus-specific PCR was positive for the 1 patient with IPA due to this species; specificity was 99% (148 of 149 samples). Aspergillus PCR identified 1 patient with IPA not diagnosed by GM. For BAL samples associated with Aspergillus colonization, the specificity of GM (92%) was higher than that of pan-Aspergillus PCR (50%; P =. 003). Among negative control samples, the specificity of pan-Aspergillus PCR (97%) was higher than that of BAL GM (88%; P =. 03). Positive results for both BAL PCR and GM testing improved the specificity to 97% with minimal detriment to sensitivity (93%). Conclusions. A recently developed pan-Aspergillus PCR assay and GM testing of BAL fluid may facilitate the diagnosis of IPA after lung transplantation. A. fumigatus- and A. terreus-specific real-time PCR assays may be useful in rapidly identifying the most common cause of IPA and a species that is intrinsically resistant to amphotericin B, respectively.

AB - Background. Early diagnosis and treatment of invasive pulmonary aspergillosis (IPA) improves outcome. Methods. We compared the performance of publicly available pan-Aspergillus, Aspergillus fumigatus-, and Aspergillus terreus-specific real-time polymerase chain reaction (PCR) assays with the Platelia galactomannan (GM) assay in 150 bronchoalveolar lavage (BAL) samples from lung transplant recipients (16 proven/probable IPA, 26 Aspergillus colonization, 11 non-Aspergillus mold colonization, and 97 negative controls). Results. The sensitivity and specificity of pan-Aspergillus PCR (optimal quantification cycle [Cq], ≤35.0 by receiver operating characteristic analysis) and GM (≥.5) for diagnosing IPA were 100% (95% confidence interval, 79%-100%) and 88% (79%-92%), and 93% (68%-100%) and 89% (82%-93%), respectively. The sensitivity and specificity of A. fumigatus-specific PCR were 85% (55%-89%) and 96% (91%-98%), respectively. A. terreus-specific PCR was positive for the 1 patient with IPA due to this species; specificity was 99% (148 of 149 samples). Aspergillus PCR identified 1 patient with IPA not diagnosed by GM. For BAL samples associated with Aspergillus colonization, the specificity of GM (92%) was higher than that of pan-Aspergillus PCR (50%; P =. 003). Among negative control samples, the specificity of pan-Aspergillus PCR (97%) was higher than that of BAL GM (88%; P =. 03). Positive results for both BAL PCR and GM testing improved the specificity to 97% with minimal detriment to sensitivity (93%). Conclusions. A recently developed pan-Aspergillus PCR assay and GM testing of BAL fluid may facilitate the diagnosis of IPA after lung transplantation. A. fumigatus- and A. terreus-specific real-time PCR assays may be useful in rapidly identifying the most common cause of IPA and a species that is intrinsically resistant to amphotericin B, respectively.

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