支气管肺泡灌洗液中曲霉菌 PCR 检测免疫功能低下患者侵袭性肺曲霉病。
Aspergillus-PCR in bronchoalveolar lavage for detection of invasive pulmonary aspergillosis in immunocompromised patients.
机构信息
Clinic of Pulmonary Medicine and Respiratory Cell Research, University Hospital Basel, Basel, Switzerland.
出版信息
BMC Infect Dis. 2012 Oct 2;12:237. doi: 10.1186/1471-2334-12-237.
BACKGROUND
Invasive fungal disease (IFD) is a frequent and serious infectious complication in immunocompromised patients. Culture and cytology in bronchoalveolar lavage (BAL) have a high specificity but low sensitivity for the diagnosis of IFD as assessed by histology. Molecular methods are expected to allow a rapid diagnosis of IFD with a high sensitivity. We evaluated the diagnostic accuracy of conventional nested PCR in the bronchoalveolar fluid to diagnose IFD in severely immunocompromised patients.
METHODS
Consecutive immunosuppressed patients undergoing bronchoscopy for suspected pulmonary infection in a tertiary care hospital were included. Patients were classified as having "proven", "probable", "possible", and "no" IFD based on definitions of the European Organization for Research and Treatment of Cancer and National Institute of Allergy and Infectious Diseases (EORTC/NIAID) and on clinical grounds. Conventional nested PCR for aspergillus fumigatus, flavus, niger, glaucus, terreus and tomarrii were applied to 2.5 ml bronchoalveolar fluid.
RESULTS
A total of 191 patients were included. Mean age was 51 y, 61% were male. There were 129 patients with hematological conditions, 26 solid organ transplant recipients, 24 auto-immune disorders, and 12 HIV. According to the EORTC/NIAID classification, there were 53 patients with potential IFD: 3 (2%) had proven, 8 (4%) probable, 42 (22%) possible and 138 (72%) no IFD. A total of 111 (58%) of the patients - 10 (90.9%) proven or probable IFD, 32 (76.2%) possible IFD and 69 (50%) "no" IFD) were on anti-fungal therapy at the time of bronchoscopy. Conventional nested PCR for Aspergillus was positive in 55 cases (28.8%). According to these results, sensitivity, specificity, PPV and NPV for "proven" IFD was 0%, 71%, 0%, 98%, respectively and "probable" IFD was 36%, 72%, 7%, 95%, respectively. In 53 (28%) cases there was a strong clinical suspicion of IFD in the chest-x-ray and/or chest-CT irrespective of the EORTC/NIAID classification. However, from those, only 15 (28%) had a positive conventional nested PCR.
CONCLUSION
In our experience, conventional nested Aspergillus PCR in the BAL seems to be of limited usefulness for detection of invasive fungal disease in immunocompromised patients due to the limited sensitivity and specificity of the method.
背景
侵袭性真菌病（IFD）是免疫功能低下患者常见且严重的感染性并发症。支气管肺泡灌洗液（BAL）中的培养和细胞学检查具有较高的特异性，但对组织学评估的 IFD 诊断敏感性较低。分子方法有望以较高的敏感性快速诊断 IFD。我们评估了常规巢式 PCR 在支气管肺泡液中诊断严重免疫功能低下患者 IFD 的诊断准确性。
方法
连续纳入在三级保健医院因疑似肺部感染而行支气管镜检查的免疫抑制患者。根据欧洲癌症研究与治疗组织和美国国立过敏与传染病研究所（EORTC/NIAID）的定义以及临床依据，患者被分类为“确诊”、“可能”、“疑似”和“无”IFD。将常规巢式 PCR 应用于 2.5ml 支气管肺泡液，以检测烟曲霉、黄曲霉、黑曲霉、青霉、构巢曲霉和土曲霉。
结果
共纳入 191 例患者。平均年龄为 51 岁，61%为男性。129 例患者有血液系统疾病，26 例有实体器官移植史，24 例有自身免疫性疾病，12 例有 HIV。根据 EORTC/NIAID 分类，有 53 例患者有潜在 IFD：3 例（2%）为确诊，8 例（4%）为可能，42 例（22%）为疑似，138 例（72%）为无 IFD。111 例（58%）患者 - 10 例（90.9%）确诊或可能 IFD、32 例（76.2%）疑似 IFD 和 69 例（50%）“无”IFD）在支气管镜检查时正在接受抗真菌治疗。常规巢式 PCR 检测曲霉菌阳性 55 例（28.8%）。根据这些结果，“确诊”IFD 的敏感性、特异性、PPV 和 NPV 分别为 0%、71%、0%、98%，“可能”IFD 分别为 36%、72%、7%、95%。在胸部 X 线和/或胸部 CT 中，53 例（28%）患者有强烈的 IFD 临床怀疑，但其中只有 15 例（28%）常规巢式 PCR 阳性。
结论
根据我们的经验，由于该方法的敏感性和特异性有限，常规巢式 PCR 检测 BAL 中的侵袭性真菌病似乎对免疫功能低下患者的 IFD 检测用处不大。
Zotero 插件