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  • 1
    Online Resource
    Online Resource
    Effect of volume of instillate on the diagnostic utility of bronchoalveolar lavage galactomannan in patients with suspected chronic pulmonary aspergillosis—A pilot study
    Wiley ; 2024
    In:  Mycoses Vol. 67, No. 1 ( 2024-01)
    Details
    In: Mycoses, Wiley, Vol. 67, No. 1 ( 2024-01)
    Abstract: Bronchoalveolar lavage (BAL) galactomannan (GM) is commonly used to diagnose Aspergillus ‐related lung diseases. However, unlike serum GM, which is measured in undiluted blood, BAL‐GM is estimated using variable aliquots and cumulative volume of instillates during bronchoscopy. Objective Since different studies have reported varying diagnostic accuracy and cut‐offs for BAL‐GM in CPA, we hypothesized that the total volume of instillate and ‘order/label’ of aliquots significantly affects the BAL‐GM values, which was evaluated as part of this study. Patients & Methods We obtained 250 BAL samples from 50 patients (five from each) with suspected chronic pulmonary aspergillosis. BAL fluid was collected after instilling sequential volumes of 40 mL of normal saline each for the first four labels and a fifth label was prepared by mixing 1 mL from each of the previous labels. The GM level of each label was measured by PLATELIA™ ASPERGILLUS Ag enzyme immunoassay. This study measured the discordance, level of agreement, diagnostic characteristics (sensitivity, specificity and AUROC) and best cut‐offs for BAL‐GM in the different aliquots of lavage fluid. Results The study population, classified into CPA (28%) and non‐CPA (72%) groups, based on ERS/ESCMID criteria (excluding BAL‐GM) were not different with respect to clinico‐radiological characteristics. The discordance of BAL‐GM positivity (using a cut‐off of 〉 1) between the serial labels for the same patient ranged between 10% and 22%, while the discordance between classification using BAL‐GM positivity (using a cut‐off of ≥1) and clinic‐radio‐microbiological classification ranged between 18% and 30%. The level of agreement for serial labels was at best fair ( 〈 0.6 for all except one ‘label’). The AUROC for the serial samples ranged between 0.595 and 0.702, with the ‘40 mL and the ‘mix’ samples performing the best. The best BAL‐GM cut‐off also showed significant variation between serial labels of varying dilutions (Range:1.01 ‐ 4.26). Interpretation This study highlights the variation in BAL‐GM measured and the ‘positivity’ between different ‘labels’ of aliquots of BAL, with the first aliquot and the mixed sample showing the best performances for diagnosis of CPA. Future studies should attempt to ‘standardise’ the instilled volume for BAL‐GM estimation to standardise the diagnostic yield.
    Type of Medium: Online Resource
    ISSN: 0933-7407 , 1439-0507
    URL: Issue
    URL: Article
    DOI: 10.1111/myc.v67.1
    DOI: 10.1111/myc.13695
    Language: English
    Publisher: Wiley
    Publication Date: 2024
    detail.hit.zdb_id: 2020780-3
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  • 2
    Online Resource
    Online Resource
    An open‐label non‐inferiority randomised control trial comparing nebulised amphotericin B with oral itraconazole in patients with pulmonary aspergilloma
    Wiley ; 2021
    In:  Mycoses Vol. 64, No. 9 ( 2021-09), p. 1038-1044
    Details
    In: Mycoses, Wiley, Vol. 64, No. 9 ( 2021-09), p. 1038-1044
    Abstract: Pulmonary aspergilloma (PA) is a common complication seen in patients with pulmonary tuberculosis sequelae. Antifungal therapy, including oral azoles, is commonly used though only surgical resection offers curative benefit. Local administration of amphotericin B, like intracavitary instillation, has been effective in aspergilloma patients though nebulised amphotericin B (nAB) has never been formally assessed. Objective The aim of this prospective, non‐inferior, open‐label, randomised control trial is to evaluate the efficacy and safety of nebulised amphotericin B compared to oral itraconazole therapy in the treatment of PA. Patients/Methods Diagnosed cases of PA (n=33) were randomised into the control group receiving oral itraconazole (n=18) and intervention group receiving nebulised amphotericin B ( n  = 15). Response to treatment was assessed both clinically and radiologically at the end 6 months. Results and Conclusion The number of patients showing overall improvement at the end of 6 months in the control arm(oral itraconazole) vs intervention arm(nebulised amphotericin B) was 65% (95% CI 38.3–85.8) and 67%(95% CI 38.4%–88.2%), respectively, in the intention‐to‐treat and 79% (95% CI 49.2%–95.3%), and 65% (95% CI 38.4%–88.2%), respectively, in the per‐protocol analysis. While there was no statistically significant difference between the intervention and control arm in both the analyses, non‐inferiority was shown in the per‐protocol but not in the intention‐to‐treat analysis. No major adverse events were noted in either group; however, a significant proportion of patients receiving nAB reported minor cough (40%), which, however, did not lead to discontinuation of therapy in any patients. Nebulised amphotericin B can be an effective therapeutic option for pulmonary aspergilloma patients.
    Type of Medium: Online Resource
    ISSN: 0933-7407 , 1439-0507
    URL: Issue
    URL: Article
    DOI: 10.1111/myc.v64.9
    DOI: 10.1111/myc.13329
    Language: English
    Publisher: Wiley
    Publication Date: 2021
    detail.hit.zdb_id: 2020780-3
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  • 3
    Online Resource
    Online Resource
    Efficacy of LD Bio Aspergillus ICT Lateral Flow Assay for Serodiagnosis of Chronic Pulmonary Aspergillosis
    MDPI AG ; 2022
    In:  Journal of Fungi Vol. 8, No. 4 ( 2022-04-14), p. 400-
    Details
    In: Journal of Fungi, MDPI AG, Vol. 8, No. 4 ( 2022-04-14), p. 400-
    Abstract: Background: The diagnosis of CPA relies on the detection of the IgG Aspergillus antibody, which is not freely available, especially in resource-poor settings. Point-of-care tests like LDBio Aspergillus ICT lateral flow assay, evaluated in only a few studies, have shown promising results for the diagnosis of CPA. However, no study has compared the diagnostic performances of LDBio LFA in setting of tuberculosis endemic countries and have compared it with that of IgG Aspergillus. Objectives: This study aimed to evaluate the diagnostic performances of LDBio LFA in CPA and compare it with existing the diagnostic algorithm utilising ImmunoCAP IgG Aspergillus. Methods: Serial patients presenting with respiratory symptoms (cough, haemoptysis, fever, etc.) for 〉 4 weeks were screened for eligibility. Relevant investigations, including direct microscopy and culture of respiratory secretions, IgG Aspergillus, chest imaging, etc., were done according to existing algorithm. Serums of all patients were tested by LDBio LFA and IgG Aspergillus (ImmunoCAP Asp IgG) and their diagnostic performances were compared. Results: A total of 174 patients were included in the study with ~66.7% patients having past history of tuberculosis. A diagnosis of CPA was made in 74 (42.5%) of patients. The estimated sensitivity and specificity of LDBio LFA was 67.6% (95% CI: 55.7–78%) and 81% (95% CI: 71.9–88.2%), respectively, which increased to 73.3% (95% CI: 60.3–83.9%) and 83.9% (95% CI: 71.7–92.4%), respectively, in patients with a past history of tuberculosis. The sensitivity and specificity of IgG Aspergillus was 82.4% (95% CI: 71.8–90.3%) and 82% (95% CI: 73.1–89%); 86.7% (95% CI: 75.4–94.1%) and 80.4% (95% CI: 67.6–89.8%), in the whole group and those with past history of tuberculosis, respectively. Conclusions: LDBio LFA is a point-of-care test with reasonable sensitivity and specificity. However, further tests may have to be done to rule-in or rule-out the diagnosis of CPA in the appropriate setting.
    Type of Medium: Online Resource
    ISSN: 2309-608X
    URL: Article
    DOI: 10.3390/jof8040400
    Language: English
    Publisher: MDPI AG
    Publication Date: 2022
    detail.hit.zdb_id: 2784229-0
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  • 4
    Online Resource
    Online Resource
    Risk factors for Coronavirus disease-associated mucormycosis
    Elsevier BV ; 2022
    In:  Journal of Infection Vol. 84, No. 3 ( 2022-03), p. 383-390
    Details
    In: Journal of Infection, Elsevier BV, Vol. 84, No. 3 ( 2022-03), p. 383-390
    Type of Medium: Online Resource
    ISSN: 0163-4453
    URL: Article
    DOI: 10.1016/j.jinf.2021.12.039
    RVK:
    XA 54270
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2022
    detail.hit.zdb_id: 2012883-6
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  • 5
    Online Resource
    Online Resource
    Utility of nasal application of lignocaine gel using cotton tip swab versus squirting with slip-tip syringe for transnasal fibreoptic bronchoscopy: a pilot randomised controlled trial
    Oxford University Press (OUP) ; 2022
    In:  Postgraduate Medical Journal Vol. 98, No. 1163 ( 2022-09-01), p. 675-679
    Details
    In: Postgraduate Medical Journal, Oxford University Press (OUP), Vol. 98, No. 1163 ( 2022-09-01), p. 675-679
    Abstract: During flexible fibreoptic bronchoscopy through the nasal route, anaesthesia of the nasal passage is achieved by lignocaine gel application by a slip-tip syringe or with the help of a cotton tip swab. No studies in existing literature have compared the two techniques in terms of efficacy. Methods 137 consecutive patients undergoing bronchoalveolar lavage (BAL) were recruited over a 2-year period. The patients underwent BAL after nasal anaesthesia—either by slip-tip syringe or by cotton tip swab smeared with 2% lignocaine gel. Patients were monitored for intraprocedural epistaxis, discomfort and improvement in operator visibility of nasal passage. Results 67 patients were randomised to cotton swab and 70 patients to the gel instillation group. There were no significant differences in terms of epistaxis, 29.9% in the cotton tip swab (95% CI 19.3% to 42.3%) versus 24.3% in the gel instillation group (95% CI 14.8% to 36%) or detection of nasal blocks, 7.5% in the cotton tip swab (95% CI 2.5% to 16.6%) versus 10% in the gel instillation group (95% CI 4.1% to 19.5%) in the two groups, although a significant difference was there in terms of visibility, 73.1% in the cotton tip swab (95% CI 60.9% to 83.2%) versus 42.9% in the gel instillation group (95% CI 31.1% to 55.3%). There was no difference in the mean pain score across the two groups either during the procedure or 1 hour after it. A short systematic review of existing literature on the topic has been provided for comparison. Conclusion Application of 2% lignocaine gel by slip-tip syringe and cotton tip swab are equivalent in terms of observed and narrated pain experienced by patients, frequency of epistaxis and nasal blocks. Vision was better preserved in the cotton tip swab group.
    Type of Medium: Online Resource
    ISSN: 0032-5473 , 1469-0756
    URL: Article
    DOI: 10.1136/postgradmedj-2020-139626
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2022
    detail.hit.zdb_id: 2009568-5
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