Mariagiovanna Cefalo1,*, Ermanno Puxeddu2, Loredana Sarmati3, Giovangiacinto Paterno1, Carla Fontana4, Daniela Nasso1,Gloria Pane2, Eleonora De Bellis1, Raffaele Palmieri1, Elisa Buzzati1, Federico Meconi1, Roberta Laureana1, Paola Casciani1, Anna Giulia Zizzari1, Paola Rogliani2, Paolo de Fabritiis1, Luca Maurillo1, Francesco Buccisano1, Maria Cantonetti1, William Arcese1, Adriano Venditti1 and Maria Ilaria Del Principe1.
1 Hematology, Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy.
2 Division of Respiratory Medicine, Department of Experimental Medicine and Surgery, University of Rome "Tor Vergata", Rome, Italy.
3 Clinical Infectious Diseases, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy.
4 Clinical Microbiology Laboratories, Department of Experimental Medicine, Tor Vergata University of Rome, Rome, Italy.
| This is an Open Access article distributed
under the terms of the Creative Commons Attribution License
(https://creativecommons.org/licenses/by-nc/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Although bronchoalveolar lavage (BAL) measurements of galactomannan
antigen (GM) seems to be more sensitive than serum testing to detect
invasive fungal infection (IFI), a consensus on the most appropriate
diagnostic threshold of the BAL GM test is still unclear. Moreover,
there is uncertainty as to whether BAL is a safe procedure in patients
with hematological malignancies (HM) and thrombocytopenia.
complications from the BAL were infrequent (3.5%) and mild. No bleeding
was reported. The BAL GM cut off of >0.8 was associated with the
best diagnostic accuracy (sensitivity 72.97% and specificity 80%).
Antifungal treatment of patients with BAL GM >0.8 resulted in a
clinical-radiological improvement in 35/41patients (85%).
Patients and Methods
|Table 1. Clinical characteristics of patients at time of BAL.|
|Figure 1A, 1B. Diagnostic performance of serum galactomannan antigen predicts a chest HRCT pattern that fulfills the EORTC/MSG criteria of probable or possible IFI.|
|Figure 2A, 2B. Diagnostic performance of galactomannan in bronchoalveolar lavage fluid predicts a chest HRCT pattern that fulfills the EORTC/MSG criteria of probable or possible IFI.|
|Table 2. Correlation between different cut off values of serum galactomannan antigen and chest HRCT patterns that fulfill the EORTC/MSG criteria of probable/possible or no fungal infection.|
|Table 3. Correlation between different cut off values of galactomannan antigen in bronchoalveolar lavage fluid and chest HRCT patterns that fulfill the EORTC/MSG criteria of probable/possible or no fungal infection.|
|Figure 3. Antifungal therapy (VORI= Voriconazole, L-AMB= liposomal amphotericin B, CASPO= caspofungin) in patients with Bronchoalveolar Lavage (BAL) galactomannan (GM) positive, and evaluation of radiological response after 30 days of treatment in patients with BAL GM>0.5, BAL GM >0.8 and BAL GM> 1.|