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Tracheal Aspirate Galactomannan Testing in COVID-19-Associated Pulmonary Aspergillosis

Among critically ill patients, COVID-19-associated pulmonary aspergillosis (CAPA) is a challenging complication. The recommended diagnostic methods for this disease are bronchoalveolar lavage (BAL) culture and galactomannan (GM) testing, which were not widely available during the pandemic. There is...

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Autores principales: Román-Montes, Carla M., Bojorges-Aguilar, Saúl, Díaz-Lomelí, Paulette, Cervantes-Sánchez, Axel, Rangel-Cordero, Andrea, Martínez-Gamboa, Areli, Sifuentes-Osornio, José, Ponce-de-León, Alfredo, González-Lara, Maria F.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10512352/
https://www.ncbi.nlm.nih.gov/pubmed/37746186
http://dx.doi.org/10.3389/ffunb.2022.855914
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author Román-Montes, Carla M.
Bojorges-Aguilar, Saúl
Díaz-Lomelí, Paulette
Cervantes-Sánchez, Axel
Rangel-Cordero, Andrea
Martínez-Gamboa, Areli
Sifuentes-Osornio, José
Ponce-de-León, Alfredo
González-Lara, Maria F.
author_facet Román-Montes, Carla M.
Bojorges-Aguilar, Saúl
Díaz-Lomelí, Paulette
Cervantes-Sánchez, Axel
Rangel-Cordero, Andrea
Martínez-Gamboa, Areli
Sifuentes-Osornio, José
Ponce-de-León, Alfredo
González-Lara, Maria F.
author_sort Román-Montes, Carla M.
collection PubMed
description Among critically ill patients, COVID-19-associated pulmonary aspergillosis (CAPA) is a challenging complication. The recommended diagnostic methods for this disease are bronchoalveolar lavage (BAL) culture and galactomannan (GM) testing, which were not widely available during the pandemic. There is scarce information regarding GM testing in other respiratory specimens. Our objective was to compare the agreement of GM between BAL and tracheal aspirate (TA) samples. We selected patients with COVID-19 and those with suspected CAPA who were admitted in the intensive care unit (ICU). GM was routinely done in BAL. We performed GM in TA samples and compared the results. The agreement was evaluated with Cohen's Kappa coefficient. GM was considered positive when an OD index ≥ 1 in BAL and ≥ 2 in TA were found. Probable CAPA was considered when the ECMM/ISHAM criteria were met. A descriptive analysis of clinical characteristics and mortality was made. We included 20 patients with suspected CAPA from 54 patients with critical COVID-19, of which 5 (9%) met the probable category. Aspergillus fumigatus was the most frequent isolate. We found moderate agreement between BAL and TA GM (Kappa = 0.47, p = 0.01, 95% CI.04–0.9), whereas TA GM had 75% sensitivity (95% CI 19.4–99.4%), 81.2% specificity (95% CI 54.4–95.9%), 50% positive predictive value (95% CI 23.8–76.3%),] and 92.8% negative predictive value (95% CI 70.1–98.6%), and 80% accuracy (95% CI 56.3–94.3%). Lastly, three (60%) patients with CAPA died during hospitalization compared to 40% (6/15) without CAPA (p = 0.4). In conclusion, a moderate agreement between TA GM and BAL was found. Therefore, TA testing may aid in ruling out CAPA due to high negative predictive value when bronchoscopies are unavailable.
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spelling pubmed-105123522023-09-22 Tracheal Aspirate Galactomannan Testing in COVID-19-Associated Pulmonary Aspergillosis Román-Montes, Carla M. Bojorges-Aguilar, Saúl Díaz-Lomelí, Paulette Cervantes-Sánchez, Axel Rangel-Cordero, Andrea Martínez-Gamboa, Areli Sifuentes-Osornio, José Ponce-de-León, Alfredo González-Lara, Maria F. Front Fungal Biol Fungal Biology Among critically ill patients, COVID-19-associated pulmonary aspergillosis (CAPA) is a challenging complication. The recommended diagnostic methods for this disease are bronchoalveolar lavage (BAL) culture and galactomannan (GM) testing, which were not widely available during the pandemic. There is scarce information regarding GM testing in other respiratory specimens. Our objective was to compare the agreement of GM between BAL and tracheal aspirate (TA) samples. We selected patients with COVID-19 and those with suspected CAPA who were admitted in the intensive care unit (ICU). GM was routinely done in BAL. We performed GM in TA samples and compared the results. The agreement was evaluated with Cohen's Kappa coefficient. GM was considered positive when an OD index ≥ 1 in BAL and ≥ 2 in TA were found. Probable CAPA was considered when the ECMM/ISHAM criteria were met. A descriptive analysis of clinical characteristics and mortality was made. We included 20 patients with suspected CAPA from 54 patients with critical COVID-19, of which 5 (9%) met the probable category. Aspergillus fumigatus was the most frequent isolate. We found moderate agreement between BAL and TA GM (Kappa = 0.47, p = 0.01, 95% CI.04–0.9), whereas TA GM had 75% sensitivity (95% CI 19.4–99.4%), 81.2% specificity (95% CI 54.4–95.9%), 50% positive predictive value (95% CI 23.8–76.3%),] and 92.8% negative predictive value (95% CI 70.1–98.6%), and 80% accuracy (95% CI 56.3–94.3%). Lastly, three (60%) patients with CAPA died during hospitalization compared to 40% (6/15) without CAPA (p = 0.4). In conclusion, a moderate agreement between TA GM and BAL was found. Therefore, TA testing may aid in ruling out CAPA due to high negative predictive value when bronchoscopies are unavailable. Frontiers Media S.A. 2022-04-08 /pmc/articles/PMC10512352/ /pubmed/37746186 http://dx.doi.org/10.3389/ffunb.2022.855914 Text en Copyright © 2022 Román-Montes, Bojorges-Aguilar, Díaz-Lomelí, Cervantes-Sánchez, Rangel-Cordero, Martínez-Gamboa, Sifuentes-Osornio, Ponce-de-León and González-Lara. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Fungal Biology
Román-Montes, Carla M.
Bojorges-Aguilar, Saúl
Díaz-Lomelí, Paulette
Cervantes-Sánchez, Axel
Rangel-Cordero, Andrea
Martínez-Gamboa, Areli
Sifuentes-Osornio, José
Ponce-de-León, Alfredo
González-Lara, Maria F.
Tracheal Aspirate Galactomannan Testing in COVID-19-Associated Pulmonary Aspergillosis
title Tracheal Aspirate Galactomannan Testing in COVID-19-Associated Pulmonary Aspergillosis
title_full Tracheal Aspirate Galactomannan Testing in COVID-19-Associated Pulmonary Aspergillosis
title_fullStr Tracheal Aspirate Galactomannan Testing in COVID-19-Associated Pulmonary Aspergillosis
title_full_unstemmed Tracheal Aspirate Galactomannan Testing in COVID-19-Associated Pulmonary Aspergillosis
title_short Tracheal Aspirate Galactomannan Testing in COVID-19-Associated Pulmonary Aspergillosis
title_sort tracheal aspirate galactomannan testing in covid-19-associated pulmonary aspergillosis
topic Fungal Biology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10512352/
https://www.ncbi.nlm.nih.gov/pubmed/37746186
http://dx.doi.org/10.3389/ffunb.2022.855914
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