The use of galactomannan detection in diagnosing invasive aspergilosis in hemato-oncological patients
Authors:
Z. Ráčil 1; I. Kocmanová 2; B. Wagnerová 1; J. Winterová 1; M. Lengerová 1; M. Moulis 3; J. Mayer 1
Authors‘ workplace:
Interní hematoonkologická klinika Lékařské fakulty MU a FN Brno, pracoviště Bohunice, přednosta prof. MUDr. Jiří Vorlíček, CSc.
1; Oddělení klinické mikrobiologie FN Brno, pracoviště Bohunice, přednostka prim. MUDr. Alena Ševčíková
2; Ústav patologie Lékařské fakulty MU a FN Brno, pracoviště Bohunice, přednosta prof. MUDr. Jirka Mačák, CSc.
3
Published in:
Vnitř Lék 2008; 54(1): 45-52
Category:
Original Contributions
Overview
Premises and objectives:
Timely diagnosis is of critical importance for the prognosis of invasive aspergilosis (IA) patients. Over recent years, IA detection of galactomannan using the ELISA method has assumed growing importance. The objective of the study was to analyse the usability of the method in current clinical practice of a hemato-oncological ward.
Patients and methods:
From May 2003 to October 2006, blood samples were taken from patients at IA risk to detect galactomannan (GM) in serum using the ELISA method. The patients who underwent the tests were classified by the probability of IA presence on the basis of the results of conventional diagnostic methods and section findings.
Results:
A total of 11,360 serum samples from 911 adult patients were tested for GM presence. IA (probable/proven) was diagnosed in 42 (4.6 %) of them. The rates of sensitivity, specificity, positive and negative predictive value of galactomannan detection for IA diagnosis in our ward were, respectively, 95.2 %, 90.0 %, 31.5 % and 99.7 %. The principal causes of the limited positive predictive value of the test were the high percentage of false-positive test results (mainly caused by concomitant administration of some penicillin antibiotics or Plasma-Lyte infusion solution), as well as the fact that a large percentage of patients we examined fell within the group of patients with hematological malignity with a very low prevalence of IA.
Conclusion:
GM detection in serum is associated with high sensitivity and excellent negative predictive value in IA diagnosis in hemato-oncological patients. Knowledge and elimination of possible causes of false-positive results as well as focusing the screening on patients at greatest risk of infection are necessary for an even better exploitation of the test.
Keywords:
invasive aspergilosis – serologic methods – aspergillus antigen – galactomannan – timely diagnosis – hematological malignity
Sources
1. Pagano L, Caira M, Candoni A et al. The epidemiology of fungal infections in patients with hematologic malignancies: the SEIFEM-2004 study. Haematologica 2006; 91: 1068-1075.
2. Fukuda T, Boeckh M, Carter RA et al. Risks and outcomes of invasive fungal infections in recipients of allogeneic hematopoietic stem cell transplants after nonmyeloablative conditioning. Blood 2003; 102: 827-833.
3. Subira M, Martino R, Franquet T et al. Invasive pulmonary aspergillosis in patients with hematologic malignancies: survival and prognostic factors. Haematologica 2002; 87: 528-534.
4. Mayer J. Nahradí transplantace periferních kmenových buněk krvetvorby definitivně transplantace kostní dřeně? Vnitř Lék 2000; 46: 785-793.
5. Lin SJ, Schranz J, Teutsch SM. Aspergillosis case-fatality rate: systematic review of the literature. Clin Infect Dis 2001; 32: 358-366.
6. von Eiff M, Roos N, Schulten R et al. Pulmonary aspergillosis: early diagnosis improves survival. Respiration 1995; 62: 341-347.
7. Brodoefel H, Vogel M, Hebart H et al. Long-term CT follow-up in 40 non-HIV immunocompromised patients with invasive pulmonary aspergillosis: kinetics of CT morphology and correlation with clinical findings and outcome. AJR Am J Roentgenol 2006; 187: 404-413.
8. Aquino VR, Goldani LZ, Pasqualotto AC. Update on the contribution of galactomannan for the diagnosis of invasive aspergillosis. Mycopathologia 2007; 163: 191-202.
9. Ráčil Z, Kocmanová I, Wagnerová B et al. Časná diagnostika invazivních mykotických infekcí u hematoonkologických nemocných pomocí sérologických metod. Vnitř Lék 2007; 53: 645-654.
10. Donnelly JP Polymerase Chain Reaction for Diagnosing Invasive Aspergillosis: Getting Closer but Still a Ways to Go. Clin Infect Dis 2006; 42: 487-489.
11. Maertens J, Verhaegen J, Demuynck H et al. Autopsy-controlled prospective evaluation of serial screening for circulating galactomannan by a sandwich enzyme-linked immunosorbent assay for hematological patients at risk for invasive Aspergillosis. J Clin Microbiol 1999; 37: 3223-3228.
12. Maertens J, Verhaegen J, Lagrou K et al. Screening for circulating galactomannan as a noninvasive diagnostic tool for invasive aspergillosis in prolonged neutropenic patients and stem cell transplantation recipients: a prospective validation. Blood 2001; 97: 1604-1610.
13. Maertens J, Van Eldere J, Verhaegen J et al. Use of circulating galactomannan screening for early diagnosis of invasive aspergillosis in allogeneic stem cell transplant recipients. J Infect Dis 2002; 186: 1297-1306.
14. Maertens J, Theunissen K, Verbeken E et al. Prospective clinical evaluation of lower cut-offs for galactomannan detection in adult neutropenic cancer patients and haematological stem cell transplant recipients. Br J Haematol 2004; 126: 852-860.
15. Pfeiffer CD, Fine JP, Safdar N Diagnosis of invasive aspergillosis using a galactomannan assay: a meta-analysis. Clin Infect Dis 2006; 42: 1417-1427.
16. Ascioglu S, Rex JH, de Pauw B et al. Defining opportunistic invasive fungal infections in immunocompromised patients with cancer and hematopoietic stem cell transplants: an international consensus. Clin Infect Dis 2002; 34: 7-14.
17. Subira M, Martino R, Rovira M et al. Clinical applicability of the new EORTC/MSG classification for invasive pulmonary aspergillosis in patients with hematological malignancies and autopsy-confirmed invasive aspergillosis. Ann Hematol 2003; 82: 80-82.
18. Ráčil Z, Kocmanová I, Wagnerová B et al. Invazivní mykotické infekce u onkologických nemocných: změny v epidemiologii a diagnostice. Postgrad Med 2007; 9: 240-252.
19. Marr KA, Balajee SA, McLaughlin L et al. Detection of galactomannan antigenemia by enzyme immunoassay for the diagnosis of invasive aspergillosis: variables that affect performance. J Infect Dis 2004; 190: 641-649.
20. Loong TW. Understanding sensitivity and specificity with the right side of the brain. BMJ 2003; 327: 716-719.
21. Hage CA, Reynolds JM, Durkin M et al. Plasmalyte as a cause of false-positive results for Aspergillus galactomannan in bronchoalveolar lavage fluid. J Clin Microbiol 2007; 45: 676-677.
22. Racil Z, Kocmanova I, Lengerova M et al. Intravenous PLASMA-LYTE as a Major Cause of False-Positive Results of Platelia Aspergillus Test for Galactomannan Detection in Serum. J Clin Microbiol 2007; 45: 3141-3142.
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