Division of Pulmonary Medicine, Rambam Health Care Campus, Haifa, Israel.
Bone Marrow Transplant. 2009 Nov;44(9):595-9. doi: 10.1038/bmt.2009.65. Epub 2009 Mar 23.
The mortality rate of 60-90% in invasive pulmonary aspergillosis (IPA) is partly explained by diagnostic delay due to the limitation of current diagnostic tests. We assessed the influence of Aspergillus species (ASP) DNA detection by PCR from bronchoalveolar lavage (BAL) fluid, a new tool for diagnosing IPA, on the outcome of this disease in immune-compromised patients. The study population comprised 107 consecutive patients with hematological malignancies from a single medical center with IPA diagnosed between 1998 and 2005. Clinical variables and mortality rates were compared between two groups diagnosed according to traditional criteria without and with PCR-based ASP DNA detection in BAL fluid. The overall mortality rate during the study period was 38.3%. The addition of PCR to the diagnostic criteria shifted 31 patients from possible to probable IPA. Patients diagnosed with probable IPA according to traditional microbiological methods had significantly higher mortality rates compared to their counterparts who had in addition a PCR-based diagnosis (80 vs 35.6%, P=0.003). This study demonstrates that PCR-based ASP DNA detection for a diagnosis of IPA from BAL fluid has a significant effect on the outcome of patients with IPA, probably related to earlier diagnosis.
侵袭性肺曲霉病（IPA）的死亡率为 60-90%，部分原因是由于目前诊断测试的局限性导致诊断延迟。我们评估了从支气管肺泡灌洗液（BAL）中检测曲霉属（ASP）DNA 的聚合酶链反应（PCR）对免疫功能低下患者IPA 疾病结局的影响，这是一种用于诊断 IPA 的新工具。研究人群包括 1998 年至 2005 年期间在一家医疗中心确诊为 IPA 的 107 例连续血液恶性肿瘤患者。根据传统标准和 BAL 液中基于 PCR 的 ASP DNA 检测，比较两组患者的临床变量和死亡率。研究期间的总死亡率为 38.3%。将 PCR 检测添加到诊断标准后，31 例患者从可能 IPA 转为确诊 IPA。根据传统微生物学方法诊断为确诊 IPA 的患者死亡率明显高于同时进行 PCR 检测的患者（80%比 35.6%，P=0.003）。这项研究表明，从 BAL 液中进行基于 PCR 的 ASP DNA 检测诊断 IPA 对 IPA 患者的结局有显著影响，可能与早期诊断有关。
