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| Diagnostic value of galacto-mannan (GM) test of bronchoalveolar lavage fluid for invasive fungal infections |
| SHAN Yu LIU Junquan▲ ZHU Yuqin LIAO Yuqin |
| Hangzhou Golden Domain Medical Laboratory Co., Ltd., Zhejiang Province, Hangzhou 310053, China |
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Abstract Objective To analyze the correlation between the results of galacto-mannan (GM) test in bronchoalveolar fluid (BALF) and the positive results of invasive pulmonary aspergillus. Methods From January 2014 to December 2016, 8086 BALF and 1459 serum from patients with respiratory disease in 650 cooperative medical institutions (including tertiary, secondary and community hospitals) in Zhejiang Province were collected. By using the GM test kits to carry out GM experiments in BALF and serum samples according to the instructions of the kit, the diagnostic value of the invasive pulmonary aspergillosis (IPA) was analyzed by the results of the I value, the IPA diagnosis compliance rate was analyzed with BALF results. Fungal culture was carried out in a conventional manner by using sand-fortified medium. Aspergillus identification: the fungal from the positive samples were cultured, so they could be subjected to 10% KOH based smear before microscopic observation, and then the Aspergillus were differentiated by their morphology and color. Results There were 1193 Aspergillus positive specimens among these 8086 BALF samples. In the Aspergillus positive samples, according to the results of I value of GM test: <0.5 for 61 cases (5.11%), 0.5 to 1 for 98 (8.21%), 1.1-2.0 for 164 (9.56%) and ＞2.1 for 870 (77.12%); and in 5103 cases which had no fungal growth, the results of I value of GM test was: <0.5 for 3623 cases (70.99%), 0.5-1 for 827 cases (16.21%), 1.1-2.0 for 376 cases (7.37%) and >2.1 for 277 cases. There was a significant difference between these two groups (P ＜ 0.01). There also was a significant difference between the Aspergillus positive group and the Candida positive group (P ＜ 0.01). The analysis of I value of GM test in BALF and invasive pulmonary aspergillosis (IPA) diagnostic coincidence rate: When the I value was set to ≥2.1, the sensitivity, specificity, positive predictive value and negative predictive value of IPA diagnosis were as follows: 77.12% 94.57%, 76.86% and 76.85%, the differences were statistically significant (P ＜ 0.01); with the analysis thatwhen I value was set to be≥0.5 for positive results (94.89%, 9.00%, 43.34% and 43.34%, respectively). The results of GM test in serum showed that the I value of the Aspergillus positive group was 0.5.63%, and the growth without fungal was only 6.54%, the differences were statistically significant (P ＜ 0.01). Conclusion When the I value is set to ≥2.1, the result of the GM test in BALF is significantly more valuable. When the I value isset to ≥0.5, the I value of GM test in serumis more appropriate.
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