Exhaled breath analysis in the diagnosis of invasive pulmonary aspergillosis

The hypothesis of this thesis was that exhaled breath analysis using electronic nose (eNose) technology can diagnose invasive pulmonary aspergillosis (IPA) with an accuracy at least comparable with galactomannan detection in broncho-alveolar lavage (BAL) fluid. The aim was:
- to explore the feasibility of this novel and non-invasive approach, and
- to determine the accuracy of galactomannan detection in BAL by means of a systematic review of the literature.
Chapter 1 provides an introductory overview of different aspects of exhaled breath analysis and IPA.
Chapter 2 is a systematic review of the literature according to the principles of The Cochrane Foundation, on the sensitivity and specificity of galactomannan detection in BAL to diagnose IPA in immunocompromised patients.
In chapter 3 we sampled airtight bottles with microbial cultures using an eNose. The eNose was able to detect whether a mold was present in a bottle. It was also able to discriminate mold species.
In chapter 4 and 5 we studied whether exhaled breath analysis using an eNose can detect colonization with A. fumigatus in CF patients and whether it can detect IPA in patients with prolonged chemotherapy-induced neutropenia. The studies showed that both have a distinct exhaled breath profile.
In chapter 7 the results of the studies are discussed within the context of the scientific literature. Concluding, this thesis has taken the first steps in the development of exhaled breath analysis as a diagnostic tool to diagnose IPA. The approach is feasible and merits further research.