肺移植受者支气管肺泡灌洗液曲霉实时聚合酶链反应检测与半乳甘露聚糖检测对侵袭性肺曲霉病的诊断比较。

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.

机构信息

Department of Medicine, University of Pittsburgh, Pennsylvania, 15261, USA.

出版信息

Clin Infect Dis. 2011 May;52(10):1218-26. doi: 10.1093/cid/cir185.

DOI:10.1093/cid/cir185

PMID:21507918

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.

摘要

背景

早期诊断和治疗侵袭性肺曲霉病（IPA）可改善预后。

方法

我们比较了公开的泛曲霉、烟曲霉和土曲霉实时聚合酶链反应（PCR）检测方法与半乳甘露聚糖（GM）检测法在 150 例肺移植受者支气管肺泡灌洗液（BAL）样本中的表现（16 例确诊/疑似 IPA、26 例曲霉定植、11 例非曲霉霉菌定植和 97 例阴性对照）。

结果

泛曲霉 PCR（最佳定量循环 [Cq]，通过接受者操作特征分析≤35.0）和 GM（≥.5）诊断 IPA 的敏感性和特异性分别为 100%（95%置信区间，79%-100%）和 88%（79%-92%），93%（68%-100%）和 89%（82%-93%）。烟曲霉特异性 PCR 的敏感性和特异性分别为 85%（55%-89%）和 96%（91%-98%）。1 例由该菌种引起 IPA 的患者 A.terreus 特异性 PCR 阳性；特异性为 99%（149 例中的 148 例）。曲霉 PCR 检测出 1 例 GM 未诊断的 IPA 患者。对于与曲霉定植相关的 BAL 样本，GM（92%）的特异性高于泛曲霉 PCR（50%；P=0.003）。在阴性对照样本中，泛曲霉 PCR 的特异性（97%）高于 BAL GM（88%；P=0.03）。同时检测 BAL PCR 和 GM 可将特异性提高到 97%，而敏感性几乎不受影响（93%）。