Detection of DNA in BALF by Real-time PCR and Galactomannan Antigen for the Early Diagnosis of Chronic Pulmonary Aspergillosis.

Objective: Studies have confirmed that real-time PCR detection of DNA in bronchoalveolar lavage fluid (BALF) is more valuable than blood samples in the diagnosis of invasive pulmonary aspergillosis (IPA). The latest guidelines recommend the use of serum samples for antibody testing for chronic pulmonary aspergillosis (CPA). However, research on CPA diagnosed by real-time PCR testing of BALF has been limited. In this study, we assessed the clinical value of BALF GM and PCR detection in diagnosing CPA.

Methods: The diagnostic criteria of this study were based on the 2015 ESCMID/ERS guidelines for CPA. Seventy-nine patients with CPA and 74 non-CPA patients were enrolled. DNA in BALF was detected in the patients with CPA.

Results: The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the curve (AUC) of BALF PCR in the CPA group were 87.18%, 89.80%, 87.18%, 89.80%, and 0.89 (95% CI 0.82-0.95), respectively (<0.005). The sensitivity, specificity, PPV, and NPV of BALF Aspergillus galactomannan (GM) detection in the CPA group were 66.67%, 89.80%, 83.87%, and 77.19%, respectively, and the AUC was 0.94 (95% CI 0.89-0.99) (<0.005). When combining BALF GM and BALF PCR detection, the sensitivity, specificity, PPV, and NPV were 92.31%, 89.80%, 87.80%, and 93.62%, respectively.

Conclusion: The BALF PCR detection method has good diagnostic value for CPA and combining this method with BALF GM detection can improve diagnostic sensitivity and specificity.