COMPARISON OF ANTIGEN-DETECTION AND PCR ASSAY USING BRONCHOALVEOLAR LAVAGE FLUID FOR DIAGNOSING INVASIVE PULMONARY ASPERGILLOSIS IN PATIENTS RECEIVING TREATMENT FOR HEMATOLOGICAL MALIGNANCIES

The performance of a sandwich enzyme-linked immunosorbent assay (ELISA ) which detects Aspergillus galactomannan (GM) was evaluated in bronch oalveolar lavage (BAL) fluid samples from 19 patients who were treated for hematological malignancies and who were suspected of having invas ive pulmonary aspergillosis (IPA). All patients had fever and pulmonar y infiltrates on the chest roentgenogram on the day that the BAL fluid was obtained. The ELISA results were compared with the results of cul ture and Aspergillus genus-specific PCR analysis of BAL fluid samples. ELISA was also performed with serum samples, Aspergillus species were detected by PCR or ELISA with BAL fluid samples from five of seven pa tients who had radiological evidence of IPA. Serum ELISA results were positive for all patients with ELISA-positive BAL fluid, and for four patients the serum ELISA was positive before the BAL fluid was obtaine d. PCR and ELISA were positive for 2 and 1 of 10 BAL fluid samples, re spectively, obtained from patients without radiological evidence of IP A, and 5 and 2 of 35 BAL fluid samples, respectively, obtained from no nneutropenic patients. This preliminary investigation suggests that GM may be detected by ELISA in BAL fluid samples from patients at risk o f IPA, but that monitoring of serum G;M levels may allow for the earli er diagnosis of IPA. However, further evaluation in prospective studie s is required.