The research on diagnostic value of fungal culture combined with galactomannan test for patients with invasive pulmonary aspergillosis
10.3969/j.issn.1008-9691.2018.02.018
- VernacularTitle:痰真菌培养联合半乳甘露聚糖试验对侵袭性肺曲霉病的诊断价值
- Author:
Lihua LIU
1
;
Yuqin ZHANG
;
Haixin DONG
;
Xuan LIU
Author Information
1. 济宁医学院附属医院检验科
- Keywords:
Galactomannan;
Fungal culture;
Invasive pulmonary aspergillosis
- From:
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
2018;25(2):189-193
- CountryChina
- Language:Chinese
-
Abstract:
Objective To assess the clinical diagnostic value of sputum fungal culture combined with serum galactomannan (GM) antigen detection in patients with invasive pulmonary aspergillosis (IPA). Methods A total of 567 cases, because of respiratory symptoms and/or suspected aspergillosis infection, admitted into the Affiliated Hospital of Jining Medical University from January to December 2016 were enrolled, the positive rate of pulmonary aspergillosis infection was determined by sputum culture and serum GM test, the values of single sputum culture and the combination of the culture and GM test for diagnosis of IPA were analyzed, and the differences in the positive rates of pulmonary aspergillus determined by GM test and traditional methods [chest computed tomography (CT), sputum culture and blood culture] were compared. At the same time, when fever patients had treated for 3-4 days, the results were ineffective, antifungal therapy was applied according to the disease condition and the results of auxiliary examinations (chest CT, sputum culture and GM test), and the effect of antifungal therapy was observed. Results The serum GM test was positive in 85 cases, and sputum fungal culture was positive in 226 cases, there were 108 cases presenting positive and 148 cases negative in both culture and GM test; the diagnosis of IFD was confirmed in 186 cases (32.8%), clinical diagnosis was made in 107 (18.9%) cases, suspected in 131 (23.1%) cases and excluded in 143 cases (25.2%). Compared with single sputum fungal culture, the sensitivity [98.2% (108/110) vs. 20.4% (46/226)], specificity [85.1% (148/174) vs. 45.1% (148/328)], positive predictive value [80.6% (108/134) vs. 37.1% (46/124)] and negative predictive value [98.1% (148/151) vs. 63.0% (148/235)] of combination method of GM test and sputum fungal culture for diagnosis of IPA were obviously higher; the positive rate of GM test for the detection of pulmonary aspergillus infection was significantly higher than that of traditional methods of chest CT, sputum culture and blood culture [64.7% (55/85) vs. 35.7% (35/98), 20.4% (46/226), 4.8% (14/292)], and the GM value being 0.5 as the positive critical value for the diagnosis of IPA can provide desirable sensitivity and specificity. In this study, 186 patients with pulmonary aspergillus infection had completed the antifungal treatment. The effective rates of antifungal treatment 1, 2, 3 and 6 months after treatment were not significantly changed with the prolongation of the therapeutic time [75.4% (135/179), 77.1% (111/144), 77.2% (31/79), 82.6% (19/23)], but the contents of serum GM was significantly lowered compared with that before treatment [absorbance (A) value: 0.49±0.03, 0.46±0.03, 0.39±0.03, 0.23±0.03 vs. 0.56±0.03, all P < 0.05], the number of positive cases was also decreased (186, 179, 144, 79, 23 respectively), so dynamic GM tests can help observe the therapeutic effect. Conclusion The study results showed: serum GM antigen detection combined with sputum fungal culture can significantly improve the clinical diagnostic efficiency for patients with pulmonary aspergillus infection.
