Division of Respiratory Medicine, Department of Pediatrics, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands.
Pediatr Pulmonol. 2013 Aug;48(8):789-96. doi: 10.1002/ppul.22670. Epub 2012 Sep 4.
Invasive pulmonary aspergillosis (IPA) is a life-threatening complication in immunocompromised patients. Early diagnosis and therapy improves outcome. Assessment of galactomannan (GM) in bronchoalveolar lavage (BAL) fluid is a proposed tool to diagnose IPA. Little is known about the diagnostic value of BAL GM in children.
Retrospectively, 72 bronchoscopies were analyzed for GM in patients fulfilling the host factor criteria as defined by the EORTC/MSG. A cut-off index value GM of ≥0.5 was used. Clinical data, results of chest CT-scans and BAL cultures were collected.
Sensitivity, specificity, PPV, and NPV of BAL GM for a diagnosis of proven and probable IPA (n = 41) were 82.4%, 87.5%, 82.4%, and 87.5% respectively. A significant relation was found for BAL GM and abnormal chest CT (P = 0.01). No significant relationship was observed between BAL Aspergillus sp. culture and chest CT (n = 47). BAL GM and serum GM correlated significantly. In 9 out of 12 patients classified as possible IPA, antifungal therapy was continued or started, despite a negative BAL GM.
BAL GM test had good diagnostic value in children suspected of IPA. However, the decision to continue or start antifungal therapy was mainly determined by the clinical suspicion of IPA based on chest CT-outcome, serum GM index values and failure of antibiotic therapy.
侵袭性肺曲霉病（IPA）是免疫功能低下患者的一种危及生命的并发症。早期诊断和治疗可改善预后。支气管肺泡灌洗液（BAL）中半乳甘露聚糖（GM）的检测被认为是诊断 IPA 的一种方法。但目前对于 BAL GM 在儿童中的诊断价值知之甚少。
回顾性分析了 72 例符合 EORTC/MSG 宿主因素标准的患者支气管镜 GM 检测结果。使用 GM 临界值指数≥0.5 作为诊断界值。收集临床资料、胸部 CT 扫描结果和 BAL 培养结果。
BAL GM 对确诊和可能 IPA（n=41）的诊断的敏感性、特异性、PPV 和 NPV 分别为 82.4%、87.5%、82.4%和 87.5%。BAL GM 与异常胸部 CT 之间存在显著相关性（P=0.01）。BAL 曲霉菌培养与胸部 CT 之间未见显著相关性（n=47）。BAL GM 和血清 GM 之间存在显著相关性。在 12 例可能 IPA 患者中，有 9 例尽管 BAL GM 检测结果为阴性，但仍继续或开始抗真菌治疗。
BAL GM 检测对疑似 IPA 的儿童具有良好的诊断价值。然而，继续或开始抗真菌治疗的决定主要取决于 IPA 的临床怀疑，包括胸部 CT 结果、血清 GM 指数值和抗生素治疗失败。
