THE ROLE OF BRONCHOSCOPY IN DIAGNOSIS INVASIVE PULMONARY ASPERGILLOSIS IN CHILDREN AFTER HEMATOPOIETIC STEM CELL TRANSPLANTATION

We have evaluated the safety and efficiency of the comprehensive examination of the bronchoalveolar lavage (BAL) (n = 222) for the diagnosis of the invasive aspergillosis of lungs (IAL) at 150 patients after the hematopoietic stem cell transplantation (HSCT) in childhood. There were no major adverse effects during the bronchoscopy. IAL was revealed at 30 % of HSCT recipients with changes in lungs at the computer tomogram. The multivariant analysis the galactomannan (GM) test in IAL showed higher sensitivity indices in comparison with the direct microscopy and inoculation (83.3 and 46.3 % accordingly). With the optic density index equal to 0.925, the diagnostic precision, showed by the area under curve at ROC-аnalaysis, was 0.794 (95 % confidence interval 0.665–0.923). The most diagnostic efficiency is achieved by the multivariant analysis, when using all 3 mentioned methods – microscopy, inoculation and GM test in IAL.

1. Климко Н. Н., Шадривова О. В., Хостелиди С. Н. и др. Инвазивный аспергиллез: результаты многоцентрового исследования. Онкогематология 2014;2:13–9. [Klimko N. N.,

2. Shadrivova O. V., Khostelidi S. N. Invasive aspergillosis: results of multicenter study. Onkogematologiya = Oncohematology 2014;2:13–9. (In Russ.)].

3. Bow E. J. Invasive fungal infection in haematopoietic stem cell transplant recipients: epidemiology from the transplant physician,s viewpoint. Mycopathologia 2009;168(6):283–97.

4. Groll A. H. ECIL 4 – Pediatric Group Considerations for Fungal Diseases and Antifungal Treatment in Children. Meeting: September 8–10th, 2011. Final version: Jan 19th, 2012. http://www.ebmt.org/ Contents/Resources/Library/ECIL/Pages/ ECIL.aspx.

5. Chamilos G., Luna M., Lewis R. et al. Invasive fungal infections in patients with hematologic malignancies in a tertiary care cancer center: an autopsy study over a 15-year period (1989–2003). Haematologica 2006;91:986–9.

6. Burgos A., Zaoutis T. E., Dvorak C. C. et al. Pediatric invasive aspergillosis: a multicenter retrospective analysis of 139 contemporary cases. Pediatrics 2008;121(12):86–94.

7. Maertens J., Van Eldere J., Verhaegen J. et al. Use of circulating galactomannan screening for early diagnosis of invasive aspergillosis in allogeneic stem cell transplant recipients. J Infect Dis 2002;186:1297–306.

8. Maertens J., Maertens V., Theunissen K. et al. Bronchoalveolar lavage fluid galactomannan for the diagnosis of invasive pulmonary aspergillosis in patients with hematologic diseases. Clin Infect Dis 2009;49(11):1688–93.

9. Maschmeyer G., Beinert T., Buchheidt D. et al. Diagnosis and antimicrobial therapy

10. of pulmonary infiltrates in febrile neutropenic patients – Guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Oncology (DGHO). Ann Hematol 2003;82(Suppl 2):118–26.

11. Desai R., Ross L. A., Hoffman J. A. The role of bronchoalveolar lavage galactomannan in the diagnosis of pediatric invasive aspergillosis. Pediatr Infect Dis J 2009;28:283–6.

12. De Mol M., de Jongste J. C., van Westreenen M. et al. Diagnosis of invasive pulmonary aspergillosis in children with bronchoalveolar lavage galactomannan. Pediatr Pulmonol 2013;48(8):789–96.

13. De Pauw B., Walsh T. J., Donnelly J. P. et al. Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/ Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group. Clin Infect Dis 2008;46(12):1813–21.

14. Sampsonas F., Kontoyiannis D. P., Dickey B. F., Evans S. E. Performance of a standardized bronchoalveolar lavage protocol in a comprehensive cancer center: a prospective 2-year study. Cancer 2011;117(15):3424–33.

15. Meyer K. C., Raghu G., Baughman R. P. et al. An official American Thoracic Society clinical practice guideline: the clinical utility of bronchoalveolar lavage cellular analysis

16. in interstitial lung disease. Am J Respir Crit Care Med 2012;185(9):1004–14.

17. Vega-Briceño L. E., Holmgren N. L., Bertrand P. et al. [Utility of bronchoalveolar lavage in immunocompromised children: diagnostic yield and complications]. [Article in Spanish]. Arch Bronconeumol 2004;40(12):570–4.

18. de Blic J., Midulla F., Barbato A. et al. Bronchoalveolar lavage in children. ERS Task Force on bronchoalveolar lavage in children. European Respiratory Society. Eur Respir J 2000;15(1):217–31