Diagnostic approaches in invasive pulmonary aspergillosis

This thesis focusses on diagnosing invasive pulmonary aspergillosis (IPA) in immunocompromised patients. The aims were to assess:
• whether low dose computed tomography (LDCT) scanning can be used to detect IPA.
• the accuracy of broncho-alveolar lavage (BAL) fluid galactomannan testing and establish the optimal usage of the test in the identification of IPA.
• whether exhaled breath analysis can be used as non-invasive test to detect IPA.
Chapter 1 provides an overview of the current diagnostic approaches for diagnosing IPA.
Chapter 2 describes a prospective study which indicates that detection of pulmonary infections (including IPA) can be improved using LDCT in the initial workup for febrile neutropenia.
Chapter 3 is a systematic review on the diagnostic accuracy of galactomannan detection in BAL fluid for diagnosing IPA in immunocompromised patients.
Chapter 4 focusses on the relevance of timing of BAL on galactomannan results.
In Chapter 5 volatile organic compound (VOC) profiles produced by Aspergillus species are detected in vitro, using gas chromatography – mass spectrometry (GC-MS). These profiles were not found in patients with IPA in vivo.
In Chapter 6 a prospective study is described, focussing on development of breath-prints enabling discrimination of patients with IPA from neutropenic controls. In contrast to previous results, such breathprints could not be detected using eNose or GC-MS analysis.
In Chapter 7 these results are discussed within the context of the scientific literature. In conclusion, this thesis shows the progress that was made developing new techniques for diagnosing IPA, and the challenges that still have to be overcome.