Title : Role of Bronchoalveolar lavage fluid galactomannan in the diagnosis of invasive pulmonary aspergillosis in non neutropenic patients
Abstract:
Invasive pulmonary aspergillosis(IPA) is typically seen in immunocompromised hosts with classical risk factors but it is now being increasingly diagnosed in apparently immunocompetent patients. Unless suspected and diagnosed early in the latter group the morbidity and mortality are high just as it is in immunocompromised hosts. The EORTC/MSG case definitions apply to immunocompromised hosts only and the bronchoalveolar lavage fluid(BALF) & serum galactomannan(GM) values have not been standardized for the non neutropenic hosts with newer risk factors. We conducted a study on 52 non neutropenic, suspected IPA patients out of which 16 were diagnosed IPA and 36 were not IPA cases. CKD as a risk factor was more common in IPA cases compared to non IPA cases (43.8% vs 13.9%, p value 0.03). Chest tomography showed cavity in significant number of IPA patients compared to non IPA cases (43.75% vs 14.3%, P value 0.021). BALF direct microscopy, culture and serum GM had sensitivities < 50% but specificities close to 95%. BALF GM showed promising results with sensitivity of 87.5% and specificity of 86.1% at cut off value 0.613. We suggest a lower cut off value of BALF GM against 1 as in EORTC/MSG criteria and to consider CKD as one of the risk factors for IPA.
