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Cornelia Lass-Flörl(1), Gudrun Resch(2), David Nachbaur(2), Astrid Mayr(1), Günther Gastl(2), Jutta Auberger(2), Ralf Bialek(3), Martin C. Freund(4)

(1)Med. Universität Innsbruck
Institut für Hygiene
Fritz-Pregl-Straße 3 / III
A - 6020 Innsbruck
Fon: +43/512/9003-70727
Fax: +43/512/9003-73700
E-mail: astrid.mayr@i-med.ac.at

(2)Clinical Division of Haematology and Oncology, Innsbruck Medical University,
(3)Clinical Microbiology, Catholic Children’s Hospital Wilhelmstift, Hamburg, Germany,
(4)Department of Radiology, University Hospital Innsbruck, Austria  

This study evaluated the utility of Calcofluor White staining (CFWS), an Aspergillus-PCR and the galactomannan enzyme immunoassay (GM EIA) for diagnosing fungal infections of computed tomography (CT) – guided percutaneous biopsies of the lung.

61 immunosuppressed patients, highly suggestive of having invasive aspergillosis due to CT chest scan, were assessed in a 3-year study period. Percutaneous CT – guided lung biopsies were obtained and investigated for the presence of fungi.

49 patients (80%) had proven fungal infection by means of hyphal positivity in the lung specimens: CFWS obtained septated in 36 (73%) and unseptated hyphae in 13 (27%) patients. In 12 patients CFWS remained negative. Cultures and molecular diagnostic procedures revealed infections due to Aspergillus spp. (A. fumigatus, A. terreus and A. flavus) and the order Mucorales (Mucor sp., Absidia corymbifera, Cunninghamella sp., Rhizomucor sp.). Sensitivity and specificity for CT scan, Aspergillus-PCR, and GM EIA from biopsy specimens were 100% and 50%, 100% and 86%, 88% and 94%, respectively. Positive predictive value for CT scan, Aspergillus-PCR, and GM EIA were 80%, 87% and 94%, respectively. 

Discrimination between Aspergillus and Non-Aspergillus infections is of high importance for therapeutic intervention as zygomycetes are resistant to voriconazole and caspofungin. The performance of CT – guided biopsies for mycological examinations are highly recommended in diagnosing fungal infections. CFWS, Aspergillus-PCR and the GM EIA are excellent tools in rapidly evaluating infections and allow guided antifungal treatment in patients with invasive fungal infections.