Clinico-microbiological diagnosis of chronic pulmonary aspergillosis among high-risk patients at a tertiary care center in India
Parul Garg, Sushil Singhal, Arti Agrawal, Sanjeev Singhal, Deeksha Agrawal, Pragya ShakyaAbstract
Background:
Invasive pulmonary aspergillosis (IPA) is a major cause of morbidity and mortality among high-risk patients, particularly those with structural lung disease or immunosuppressive conditions. Conventional diagnostic methods, including fungal culture, have limited sensitivity, underscoring the need for more reliable adjunctive diagnostic tools, such as galactomannan (GM) testing in bronchoalveolar lavage (BAL).
Objectives:
To evaluate the clinico-microbiological profile of IPA in high-risk patients and to assess the diagnostic performance of BAL GM testing relative to conventional fungal culture.
Materials and Methods:
This retrospective study included BAL samples from high-risk patients with suspected pulmonary aspergillosis at a tertiary care center in India. All samples underwent potassium hydroxide (KOH) wet mount, fungal culture, and BAL GM enzyme-linked immunosorbent assay. We classified patients as having proven, probable, or possible IPA according to the European Organization for Research and Treatment of Cancer/Mycoses Study Group Education and Research Consortium criteria.
Results:
Of 123 patients with chronic pulmonary infections, 62.5% were classified as probable IPA, 35.0% as possible IPA, and 2.5% as proven IPA. BAL GM positivity (optical density index ≥ 1.0) was observed in 56.25% of patients, whereas fungal culture was positive in only 20.0%. Among patients with probable IPA, BAL GM was positive in 44%, compared with a culture positivity rate of 30%.
Conclusion:
BAL GM testing demonstrated superior diagnostic performance compared with conventional fungal culture and is a valuable adjunctive tool for diagnosing pulmonary aspergillosis in high-risk patients.