Bronchoalveolar lavage fluid metagenomic testing
Improved diagnosis, Improved outcomes
Standard of care (SOC) testing for individuals with serious lung infections typically involves more than a dozen different tests that, in up to 70% of cases, fail to identify the correct cause and can potentially contribute to high mortality rates.1,2 Metagenomic sequencing of microbial cell-free DNA circulating in bronchoalveolar lavage fluid (BALF) is an alternative testing approach that can quickly and accurately identify the causative agent.
The Karius Focus™ | BAL assay is a pioneering assay that can detect and classify more than 500 pathogens, including bacteria, DNA viruses, fungi, and parasites associated with lung infections in BALF. With results typically available within one day of sample receipt, answers from Karius Focus | BAL enable faster treatment, improved outcomes, and reduced mortality in high-risk patients.
Bronchoalveolar lavage (BAL) fluid metagenomic test menu
Karius Focus
Compared with SOC BAL tests, which can require multiple cultures, stains, and polymerase chain reaction (PCR) panels with limited yield, Karius Focus | BAL can provide comprehensive pathogen detection from a single sample, often within one day. Offering a 50% greater diagnostic yield than all SOC tests combined, the Karius metagenomic sequencing test can clarify the cause in cases of pneumonia, invasive fungal infections, and other types of atypical infections.
Patients who may be appropriate for this testing include:
- Those with symptoms such as fever, cough, shortness of breath, chest pain, or abnormal imaging.
- Individuals with pneumonia, invasive fungal infection, or other atypical lung infections.
- Immunocompromised individuals, including patients who have undergone hematopoietic stem cell or solid organ transplants, have hematologic malignancies, or are receiving chemotherapy.
- Any patient in whom a bronchoscopy with BAL is clinically indicated for evaluation of pneumonia or unexplained pulmonary infiltrates may be a candidate.
Key testing
- KDBAL | Karius Focus Direct, BAL
- KBAL | Karius Focus, Bronchoalveolar Lavage
Advantages
- Detects more than 500 pathogens, including 350+ bacteria, 115+ fungi, 15+ DNA Viruses, and 30+ parasites.
- Requires just 1 mL of BALF.
- Helps to eliminate or reduce low-yield diagnostic testing requiring invasive tissue or fluid collection.
- Results typically available one day after specimen receipt.
- Rapid results enable timely initiation of targeted therapies.
- Empowers clinicians to deliver more effective and personalized care.
Included pathogens
- Achromobacter denitrificans
- Achromobacter xylosoxidans
- Acinetobacter baumannii
- Acinetobacter calcoaceticus
- Acinetobacter pittii
- Actinomucor elegans
- Actinomyces gerencseriae
- Actinomyces graevenitzii
- Actinomyces israelii
- Actinomyces massiliensis
- Actinomyces oris
- Actinomyces viscosus
- Aeromonas caviae
- Aeromonas hydrophila
- Aeromonas veronii
- Aggregatibacter actinomycetemcomitans
- Aggregatibacter aphrophilus
- Alcaligenes faecalis
- Alloscardovia omnicolens
- Anaerococcus prevotii
- Ancylostoma ceylanicum
- Ancylostoma duodenale
- Apophysomyces elegans
- Apophysomyces trapeziformis
- Apophysomyces variabilis
- Arcanobacterium haemolyticum
- Ascaris
- Aspergillus aculeatus
- Aspergillus brasiliensis
- Aspergillus calidoustus
- Aspergillus candidus
- Aspergillus chevalieri
- Aspergillus clavatus
- Aspergillus fischeri
- Aspergillus flavus
- Aspergillus fumigatus
- Aspergillus glaucus
- Aspergillus lentulus
- Aspergillus luchuensis
- Aspergillus nidulans
- Aspergillus niger
- Aspergillus nomiae
- Aspergillus novofumigatus
- Aspergillus oryzae
- Aspergillus persii
- Aspergillus sclerotiorum
- Aspergillus terreus
- Aspergillus thermomutatus
- Aspergillus tubingensis
- Aspergillus udagawae
- Aspergillus ustus
- Aspergillus versicolor
- Aspergillus wentii
- Aureobasidium pullulans
- Babesia divergens
- Babesia microti
- Bacillus cereus
- Bacillus subtilis
- Bacteroides fragilis
- Bacteroides ovatus
- Bacteroides thetaiotaomicron
- Bartonella alsatica
- Bartonella ancashensis
- Bartonella bacilliformis
- Bartonella clarridgeiae
- Bartonella doshiae
- Bartonella elizabethae
- Bartonella grahamii
- Bartonella henselae
- Bartonella koehlerae
- Bartonella quintana
- Bartonella rochalimae
- Bartonella schoenbuchensis
- Bartonella tribocorum
- Bartonella vinsonii
- Bifidobacterium longum
- Blastomyces dermatitidis
- Blastomyces percursus
- Blastomyces silverae (Emmonsia parva)
- Bordetella avium
- Bordetella bronchialis
- Bordetella bronchiseptica
- Bordetella flabilis
- Bordetella hinzii
- Bordetella holmesii
- Bordetella parapertussis
- Bordetella pertussis
- Bordetella petrii
- Brucella abortus
- Brucella anthropi (Ochrobactrum anthropi)
- Brucella canis
- Brucella melitensis
- Brucella suis
- Burkholderia cepacia complex
- Burkholderia gladioli
- Burkholderia mallei
- Burkholderia pseudomallei
- Campylobacter gracilis
- Campylobacter sputorum
- Candida albicans
- Candida auris
- Candida dubliniensis
- Candida glabrata
- Candida parapsilosis
- Candida tropicalis
- Capnocytophaga canimorsus
- Capnocytophaga cynodegmi
- Capnocytophaga gingivalis
- Capnocytophaga granulosa
- Capnocytophaga haemolytica
- Capnocytophaga ochracea
- Capnocytophaga sputigena
- Cedecea davisae
- Cedecea neteri
- Chlamydia pneumoniae
- Chlamydia psittaci
- Chlamydia trachomatis
- Chromobacterium violaceum
- Chryseobacterium gleum
- Chryseobacterium indologenes
- Citrobacter amalonaticus
- Citrobacter braakii
- Citrobacter farmeri
- Citrobacter freundii
- Citrobacter koseri
- Citrobacter sedlakii
- Cladophialophora bantiana
- Cladosporium cladosporioides
- Clavispora lusitaniae (Candida lusitaniae)
- Clonorchis sinensis
- Clostridium perfringens
- Coccidioides immitis
- Coccidioides posadasii
- Cokeromyces recurvatus
- Corynebacterium accolens
- Corynebacterium afermentans
- Corynebacterium argentoratense
- Corynebacterium diphtheriae
- Corynebacterium jeikeium
- Corynebacterium propinquum
- Corynebacterium pseudodiphtheriticum
- Corynebacterium pseudotuberculosis
- Corynebacterium striatum
- Corynebacterium ulcerans
- Corynebacterium urealyticum
- Corynebacterium xerosis
- Coxiella burnetii
- Cronobacter sakazakii (Enterobacter sakazakii)
- Cryptococcus gattii VGI (Cryptococcus gattii)
- Cryptococcus gattii VGII (Cryptococcus deuterogattii)
- Cryptococcus gattii VGIII (Cryptococcus bacillisporus)
- Cryptococcus gattii VGIV (Cryptococcus tetragattii)
- Cryptococcus neoformans
- Cryptosporidium hominis
- Cryptosporidium parvum
- Cunninghamella
- Cupriavidus gilardii
- Cupriavidus metallidurans
- Cupriavidus pauculus
- Curvularia lunata
- Cutaneotrichosporon cutaneum (Trichosporon cutaneum)
- Cyclospora cayetanensis
- Cytomegalovirus (CMV)
- Dirofilaria immitis
- Dolosigranulum pigrum
- Echinococcus granulosus
- Echinococcus multilocularis
- Ehrlichia chaffeensis
- Eikenella corrodens
- Elizabethkingia anophelis
- Elizabethkingia meningoseptica
- Elizabethkingia miricola
- Emmonsia crescens
- Encephalitozoon cuniculi
- Encephalitozoon hellem
- Encephalitozoon intestinalis
- Entamoeba histolytica
- Enterobacter cloacae complex
- Enterococcus faecalis
- Enterococcus faecium
- Enterocytozoon bieneusi
- Epstein-Barr virus (EBV)
- Erysipelothrix rhusiopathiae
- Escherichia coli
- Exophiala dermatitidis
- Exophiala spinifera
- Finegoldia magna
- Fluoribacter bozemanae (Legionella bozemanae)
- Fluoribacter dumoffii (Legionella dumoffii)
- Fonsecaea monophora
- Fonsecaea nubica
- Fonsecaea pedrosoi
- Francisella philomiragia
- Francisella tularensis
- Fusarium fujikuroi
- Fusarium nygamai
- Fusarium oxysporum
- Fusarium proliferatum
- Fusarium solani
- Fusarium verticillioides
- Fusobacterium mortiferum
- Fusobacterium necrophorum
- Fusobacterium nucleatum
- Gemella morbillorum
- Geotrichum candidum
- Gordonia aichiensis
- Gordonia bronchialis
- Gordonia otitidis
- Gordonia rubripertincta
- Granulicatella adiacens
- Haemophilus haemolyticus
- Haemophilus influenzae
- Haemophilus parahaemolyticus
- Haemophilus parainfluenzae
- Haemophilus paraphrohaemolyticus
- Haemophilus quentini
- Haemophilus sputorum
- Hafnia alvei
- Helcococcus kunzii
- Herpes simplex virus type 1 (HSV-1)
- Herpes simplex virus type 2 (HSV-2)
- Histoplasma capsulatum
- Human adenovirus B
- Human adenovirus C
- Human adenovirus E
- Human bocavirus
- Human herpesvirus 6A
- Human herpesvirus 6B
- Klebsiella aerogenes (Enterobacter aerogenes)
- Klebsiella michiganensis
- Klebsiella oxytoca
- Klebsiella pneumoniae
- Klebsiella quasipneumoniae
- Klebsiella variicola
- Kocuria rhizophila
- Legionella anisa
- Legionella birminghamensis
- Legionella cherrii
- Legionella cincinnatiensis
- Legionella clemsonensis
- Legionella feeleii
- Legionella hackeliae
- Legionella jamestowniensis
- Legionella jordanis
- Legionella lansingensis
- Legionella londiniensis
- Legionella longbeachae
- Legionella maceachernii
- Legionella norrlandica
- Legionella oakridgensis
- Legionella parisiensis
- Legionella pneumophila
- Legionella rubrilucens
- Legionella sainthelensi
- Legionella steelei
- Legionella tucsonensis
- Legionella wadsworthii
- Legionella waltersii
- Legionella worsleiensis
- Leishmania aethiopica
- Leishmania amazonensis
- Leishmania braziliensis
- Leishmania donovani
- Leishmania infantum
- Leishmania major
- Leishmania mexicana
- Leishmania panamensis
- Leishmania tropica
- Leptospira borgpetersenii
- Leptospira broomii
- Leptospira fainei
- Leptospira interrogans
- Leptospira kirschneri
- Leptospira kmetyi
- Leptospira licerasiae
- Leptospira mayottensis
- Leptospira noguchii
- Leptospira santarosai
- Leptospira weilii
- Lichtheimia corymbifera
- Lichtheimia ramosa
- Listeria monocytogenes
- Lomentospora prolificans
- Lysinibacillus sphaericus (Bacillus sphaericus)
- Monkeypox virus
- Moraxella atlantae
- Moraxella catarrhalis
- Morganella morganii
- Mucor circinelloides
- Mucor indicus
- Mucor irregularis
- Mucor velutinosus
- Mycobacterium asiaticum
- Mycobacterium avium complex (MAC)
- Mycobacterium celatum
- Mycobacterium chimaera
- Mycobacterium genavense
- Mycobacterium haemophilum
- Mycobacterium heckeshornense
- Mycobacterium intermedium
- Mycobacterium kansasii
- Mycobacterium kyorinense
- Mycobacterium malmoense
- Mycobacterium marinum
- Mycobacterium nebraskense
- Mycobacterium paraffinicum
- Mycobacterium parascrofulaceum
- Mycobacterium scrofulaceum
- Mycobacterium sherrisii
- Mycobacterium shigaense
- Mycobacterium shimoidei
- Mycobacterium simiae
- Mycobacterium talmoniae
- Mycobacterium triplex
- Mycobacterium tuberculosis complex
- Mycobacterium xenopi
- Mycobacteroides abscessus (Mycobacterium abscessus)
- Mycobacteroides chelonae (Mycobacterium chelonae)
- Mycobacteroides franklinii (Mycobacterium franklinii)
- Mycolicibacillus koreensis (Mycobacterium koreense)
- Mycolicibacter arupensis (Mycobacterium arupense)
- Mycolicibacter kumamotonensis (Mycobacterium kumamotonense)
- Mycolicibacterium aurum
- Mycolicibacterium brisbanense (Mycobacterium brisbanense)
- Mycolicibacterium canariasense (Mycobacterium canariasense)
- Mycolicibacterium conceptionense (Mycobacterium conceptionense)
- Mycolicibacterium cosmeticum (Mycobacterium cosmeticum)
- Mycolicibacterium elephantis (Mycobacterium elephantis)
- Mycolicibacterium flavescens (Mycobacterium flavescens)
- Mycolicibacterium fortuitum (Mycobacterium fortuitum)
- Mycolicibacterium goodii (Mycobacterium goodii)
- Mycolicibacterium hassiacum
- Mycolicibacterium iranicum (Mycobacterium iranicum)
- Mycolicibacterium llatzerense (Mycobacterium llatzerense)
- Mycolicibacterium mageritense (Mycobacterium mageritense)
- Mycolicibacterium mucogenicum (Mycobacterium mucogenicum)
- Mycolicibacterium neoaurum (Mycobacterium neoaurum)
- Mycolicibacterium novocastrense (Mycobacterium novocastrense)
- Mycolicibacterium obuense (Mycobacterium obuense)
- Mycolicibacterium peregrinum (Mycobacterium peregrinum)
- Mycolicibacterium septicum (Mycobacterium septicum)
- Mycolicibacterium smegmatis (Mycobacterium smegmatis)
- Mycolicibacterium thermoresistibile (Mycobacterium thermoresistibile)
- Mycolicibacterium vaccae (Mycobacterium vaccae)
- Mycoplasma hominis
- Mycoplasma pneumoniae
- Mycoplasmopsis arginini (Mycoplasma arginini)
- Neisseria meningitidis
- Nocardia abscessus
- Nocardia africana
- Nocardia amamiensis
- Nocardia araoensis
- Nocardia arizonensis
- Nocardia arthritidis
- Nocardia asiatica
- Nocardia beijingensis
- Nocardia brasiliensis
- Nocardia caishijiensis
- Nocardia carnea
- Nocardia cerradoensis
- Nocardia concava
- Nocardia cyriacigeorgica
- Nocardia elegans
- Nocardia exalbida
- Nocardia farcinica
- Nocardia flavorosea
- Nocardia higoensis
- Nocardia ignorata
- Nocardia kruczakiae
- Nocardia mexicana
- Nocardia mikamii
- Nocardia niwae
- Nocardia nova
- Nocardia otitidiscaviarum
- Nocardia paucivorans
- Nocardia pneumoniae
- Nocardia pseudobrasiliensis
- Nocardia sienata
- Nocardia takedensis
- Nocardia terpenica
- Nocardia testacea
- Nocardia thailandica
- Nocardia transvalensis
- Nocardia veterana
- Ochroconis constricta
- Ophiostoma piceae
- Orientia tsutsugamushi
- Paeniclostridium sordellii (Clostridium sordellii)
- Pandoraea apista
- Pantoea agglomerans
- Parachlamydia acanthamoebae
- Paracoccidioides brasiliensis
- Paracoccidioides lutzii
- Pasteurella multocida
- Penicillium capsulatum
- Penicillium digitatum
- Peptostreptococcus anaerobius
- Phanerodontia chrysosporium (Phanerochaete chrysosporium)
- Phocaeicola vulgatus (Bacteroides vulgatus)
- Pichia kudriavzevii (Candida krusei)
- Plasmodium cynomolgi
- Plasmodium falciparum
- Plasmodium knowlesi
- Plasmodium malariae
- Plasmodium ovale
- Plasmodium vivax
- Plesiomonas shigelloides
- Pneumocystis jirovecii
- Prevotella buccae
- Prevotella buccalis
- Prevotella intermedia
- Prevotella melaninogenica
- Prevotella oralis
- Primate bocaparvovirus 1
- Proteus mirabilis
- Proteus vulgaris
- Providencia rettgeri
- Providencia stuartii
- Pseudomonas aeruginosa
- Pseudomonas fluorescens
- Pseudomonas mosselii
- Pseudomonas putida
- Purpureocillium lilacinum
- Ralstonia insidiosa
- Ralstonia mannitolilytica
- Raoultella ornithinolytica
- Raoultella planticola
- Rhizomucor miehei
- Rhizomucor pusillus
- Rhizomucor variabilis
- Rhizopus arrhizus (Rhizopus oryzae)
- Rhizopus delemar
- Rhizopus microsporus
- Rhizopus stolonifer
- Rhodococcus hoagii (Rhodococcus equi)
- Rickettsia akari
- Rickettsia australis
- Rickettsia conorii
- Rickettsia felis
- Rickettsia helvetica
- Rickettsia honei
- Rickettsia japonica
- Rickettsia massiliae
- Rickettsia monacensis
- Rickettsia parkeri
- Rickettsia prowazekii
- Rickettsia raoultii
- Rickettsia rickettsii
- Rickettsia sibirica
- Rickettsia slovaca
- Rickettsia typhi
- Rodentibacter pneumotropicus (Pasteurella pneumotropica)
- Rothia aeria
- Rothia kristinae (Kocuria kristinae)
- Rothia mucilaginosa
- Salmonella enterica
- Scedosporium apiospermum
- Scedosporium aurantiacum
- Scedosporium boydii
- Scedosporium dehoogii
- Schaalia meyeri (Actinomyces meyeri)
- Schaalia odontolytica (Actinomyces odontolyticus)
- Schistosoma haematobium
- Schistosoma japonicum
- Schistosoma mansoni
- Schizophyllum commune
- Serratia liquefaciens
- Serratia marcescens
- Serratia odorifera
- Shewanella algae
- Shewanella putrefaciens
- Slackia exigua
- Sporothrix brasiliensis
- Sporothrix globosa
- Sporothrix schenckii
- Staphylococcus argenteus
- Staphylococcus aureus
- Stenotrophomonas maltophilia
- Streptobacillus moniliformis
- Streptococcus agalactiae
- Streptococcus anginosus
- Streptococcus constellatus
- Streptococcus intermedius
- Streptococcus pneumoniae
- Streptococcus pseudopneumoniae
- Streptococcus pyogenes
- Strongyloides stercoralis
- Syncephalastrum racemosum
- Talaromyces amestolkiae
- Talaromyces marneffei (Penicillium marneffei)
- Talaromyces purpureogenus (Penicillium purpurogenum)
- Talaromyces verruculosus (Penicillium verruculosum)
- Tatlockia micdadei (Legionella micdadei)
- Thermoascus crustaceus
- Thermothelomyces thermophilus (Myceliophthora thermophila)
- Toxocara canis
- Toxoplasma gondii
- Treponema pallidum
- Trichoderma longibrachiatum
- Trichosporon asahii
- Trichosporon faecale
- Trichosporon inkin
- Tropheryma whipplei
- Trueperella bernardiae (Arcanobacterium bernardiae)
- Trueperella pyogenes (Arcanobacterium pyogenes)
- Tsukamurella paurometabola
- Tsukamurella pulmonis
- Tsukamurella tyrosinosolvens
- Ureaplasma parvum
- Ureaplasma urealyticum
- Varicella-zoster virus (VZV)
- Variola virus
- Verruconis gallopava (Ochroconis gallopava)
- Vibrio alginolyticus
- Vibrio metschnikovii
- Vibrio vulnificus
- WU polyomavirus (Betapolyomavirus quartihominis)
- Wuchereria bancrofti
- Yersinia enterocolitica
- Yersinia pestis
- Yersinia pseudotuberculosis
Click here To view the most up-to-date pathogen list.
Learn more View our cerebrospinal fluid metagenomics testing
Learn more View our plasma metagenomics testing
References
- Bergin SP, et al. Clinical Infectious Diseases. 2023;ciad599.
- Schuster MG, et al. Open Forum Infect Dis. 2017;4(2):ofx050.
- Unpublished internal data from analysis performed on patients enrolled in PICKUP study; n=118; Karius Focus BAL identified adjudicated cause of pneumonia in 40 patients versus 29 with SOC alone