Evaluating the clinical utility of Aspergillus, Mucorales, and Nocardia bronchoalveolar PCRs for the diagnosis of invasive pulmonary infections in patients with hematological malignancies Journal Article
| Authors: | Gali, V.; Al-Ghanamah, R.; Finnigan, K.; Kalchiem-Dekel, O.; Kamboj, M.; Hohl, T. M.; Babady, N. E.; Papanicolaou, G. A.; Lee, Y. J. |
| Article Title: | Evaluating the clinical utility of Aspergillus, Mucorales, and Nocardia bronchoalveolar PCRs for the diagnosis of invasive pulmonary infections in patients with hematological malignancies |
| Abstract: | Invasive pulmonary infections are a significant cause of morbidity and mortality in patients with hematological malignancies and hematopoietic stem cell transplantation (HCT) recipients. A delay in identifying a causative agent may result in late initiation of appropriate treatment and adverse clinical outcomes. We examine the diagnostic utility of PCR-based assays in evaluating invasive pulmonary infections from bronchoalveolar lavage (BAL). Patients with hematological malignancies and HCT recipients who underwent bronchoscopy with BAL from January 2020 to January 2024 for unexplained pulmonary infiltrates and had ≥1 PCR targeting Aspergillus, Mucorales, or Nocardia (Eurofins-Viracor, KS) were reviewed. Testing for microbiology and pathology except BAL PCRs to identify the etiology of pulmonary infiltrate was defined as standard-of-care. Invasive fungal diseases were defined as per European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium (EORTC/MSGERC) 2020 guidelines. Pulmonary nocardiosis was defined by a combination of clinical, radiographic, and microbiologic criteria. Of 134 patients, 77 were HCT recipients, and 70% were on antifungal agents. Thirty-two were diagnosed with infection with one of the three target pathogens, including 20 with probable or proven invasive pulmonary aspergillosis (IPA), seven with mucormycosis, and three with nocardiosis. For IPA, 19 were diagnosed by standard-of-care, and one (5%) was solely diagnosed by Aspergillus PCR. Mucorales PCR was positive in three of seven cases of proven mucormycosis, but the cultures were negative in all. All three nocardiosis cases were detected by PCR and culture. In our cohort, PCR targeting Mucorales and Nocardia can improve the early detection of invasive pulmonary infection, whereas Aspergillus PCR has a low added value when done in conjunction with standard-of-care, including BAL galactomannan. Copyright © 2025 Gali et al. |
| Keywords: | adult; aged; middle aged; retrospective studies; major clinical study; genetics; polymerase chain reaction; cohort analysis; hematopoietic stem cell transplantation; retrospective study; hematologic malignancy; hematologic neoplasms; diagnosis; hematologic malignancies; bronchoscopy; immunocompromised host; drug therapy; microbiology; lung infection; matrix assisted laser desorption ionization time of flight mass spectrometry; isolation and purification; fluconazole; aspergillus; echinocandin; aspergillus fumigatus; aspergillosis; galactomannan; hematologic disease; immunocompromised patient; lung lavage; invasive pulmonary aspergillosis; adverse event; complication; bronchoalveolar lavage fluid; procedures; hematopoietic stem cell transplant; lung mycosis; amphotericin b; lung diseases, fungal; humans; human; male; female; article; nocardia; nocardiosis; mucormycosis; nocardia infections; mucorales; aspergillus pcr; bronchioalveolar lavage; invasive pulmonary infections; mucorales pcr; nocardia pcr; pulmonary mucormycosis; pulmonary nocardiosis; invasive pulmonary infection |
| Journal Title: | Journal of Clinical Microbiology |
| Volume: | 63 |
| Issue: | 2 |
| ISSN: | 0095-1137 |
| Publisher: | American Society for Microbiology |
| Date Published: | 2025-02-01 |
| Start Page: | e01355-24 |
| Language: | English |
| DOI: | 10.1128/jcm.01355-24 |
| PUBMED: | 39817757 |
| PROVIDER: | scopus |
| PMCID: | PMC11837534 |
| DOI/URL: | |
| Notes: | The MSK Cancer Center Support Grant (P30 CA008748) is acknowledged in the PubMed record and PDF. Corresponding MSK author is Yeon Joo Lee -- Source: Scopus |
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