Galactomannan Antigen Concordance in Bronchoscopic Bronchoalveolar Lavage and Blind Mini Bronchoalveolar Lavage
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Abstract
Introduction: viral pneumonias increase the susceptibility to develop fungal secondary infections. With COVID-19 pandemic, multiple cases of invasive pulmonary aspergillosis associated with COVID-19 (PAAC) have been reported, increasing mortality. It is not recommended to perform bronchoscopy during COVID-19 illness given the risk of aerosolization, so new techniques such as mini bronchoalveolar lavage (BAL) emerge. The necessity to perform a validating task for the galactomannan (GM) measurement in samples obtained through mini-BAL emerges from the absence of cutting points for the GM antigen positivity in respiratory samples non obtained by bronchoscopy.
Aim: to validate the concordance of GM measurement in respiratory samples obtained through mini-BAL and BAL by bronchoscopy.
Material and methods: observational and analytical prospective study. Patients admitted to intensive care unit with suspected PAAC who were asked to obtain respiratory samples for MG study were included. In all the cases, BAL and mini-BAL samples were obtained in one same procedure. It was considered positive GM with a value higher than 1.
Results: 11 patients were studied, 6 (54.5%) cases were diagnosed positive for PAAC through bronchoscopic BAL. The mini-BAL sensitivity was 33% and the specificity 100%; predictive positive value 100% and negative predictive value 55%. The concordance correlation coefficient was 0,28% (IC -0,078 a 0,57), which showed a poor concordance between both methods.
Conclusion: The GM test through mini-BAL could prove to be a fine confirmatory method, while a negative result does not discard PAAC.
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