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Published on: March 22, 2012
False-positive galactomannan assay in broncho-alveolar lavage after enteral nutrition solution inhalation: a case
Olivier Lheureux1, Isabel Montesinos2, Olivier Taton3
1Department of Intensive Care, CUB - Erasme, Université Libre de Bruxelles (ULB), Route de Lennik 808, 1070 Brussels, Belgium.
Abstract:
Introduction. Diagnosis of invasive aspergillosis is challenging and the gold standard for definite diagnosis remains histopathological tissue examination. However, invasive procedures such as lung biopsy are often not feasible in critically ill patients. The detection of fungal cell wall components like Aspergillus galactomannan in broncho-alveolar lavage remains a key component of the diagnostic procedure. False-positive of the Aspergillus galactomannan assay is not frequent. Case presentation. We report a case of positive galactomannan in broncho-alveolar lavage fluid after enteral nutrition aspiration without signs of invasive aspergillosis. Galactomannan was positive in the enteral nutrition solution. Conclusion. Physicians should be aware of this previously unrecognized cause of false-positive galactomannan in broncho-alveolar fluid which can result in unnecessary treatments.
Insights
A positive Aspergillus galactomannan assay in broncho-alveolar lavage fluid can be a false positive. Enteral nutrition aspiration can cause false-positive galactomannan results, leading to unnecessary treatments.
Area of Science:
- Medical Diagnostics
- Mycology
- Critical Care Medicine
Background:
- Invasive aspergillosis diagnosis is challenging, especially in critically ill patients where invasive procedures are often not feasible.
- Histopathological tissue examination is the gold standard, but less invasive methods are crucial.
- Detection of Aspergillus galactomannan in broncho-alveolar lavage fluid is a key diagnostic component.
Observation:
- A case of positive galactomannan in broncho-alveolar lavage fluid is presented.
- This positivity occurred after enteral nutrition aspiration.
- The patient showed no signs of invasive aspergillosis.
Findings:
- The enteral nutrition solution itself tested positive for galactomannan.
- This indicates a non-infectious source for the positive assay result.
- Enteral nutrition aspiration is a previously unrecognized cause of false-positive galactomannan.
Implications:
- Physicians must consider enteral nutrition aspiration as a potential cause of false-positive galactomannan results.
- Awareness can prevent unnecessary antifungal treatments.
- This highlights the importance of correlating diagnostic tests with clinical context.
