The contribution of galactomannan detection in the diagnosis of invasive aspergillosis in bone marrow transplant recipients
- 88 Downloads
Until recently, accurate microbiological diagnosis of invasive aspergillosis (IA) was seldom established in HSCT recipients. Blood samples are rarely positive for Aspergillus species, the reliability of the cultures depends of the specimen (if taken from a normally sterile site or not) and biopsy samples require invasive procedures, rarely recommended in patients with severe thrombocytopenia. Implementing the international consensus defining the microbiological criteria for the diagnosis of Aspergillus infection, we retrospectively evaluated the role of serum galactomannan (GM) detection by EIA to diagnose IA among HSCT patients with proven invasive fungal infection (IFI) and the impact of serum storage in GM concentrations. The EIA assay allowed categorizing as “probable” 5 of the 10 cases of “possible” aspergillosis (50%). Considering a lower cut-off level for the reaction (1.0), 80% of the cases could be categorized as “probable” aspergillosis. Positive or undetermined results were detected one to 4 months before the diagnosis of IA in eight of the 11 patients (72.7%) with proven IFI. Retesting the stored samples after a second storage for four years, we could observe lower reactivity in 20% of the samples. The detection of galactomannan by the EIA test represents a major advance in the diagnosis of IA in HSCT recipients at high risk of IA. A better understanding of the kinetics of the GM in different clinical situations is necessary to maximize the benefit of the test in Aspergillus surveillance.
Keywordsantigen detection Aspergillosis galactomannan HSCT Platelia serum storage
Unable to display preview. Download preview PDF.
- 2.Ascioglu, S, Rex, JH, Paw, B, Bennett, JE, Bille, J, Crokaert, F, Denning, DW, Donnelly, JP, Edwards, JE, Erjavec, Z, Fierce, D, Lortholary, O, Maertens, J, Meis, JF, Patterson, TF, Ritter, J, Selleslag, D, Shah, PM, Stevens, DA, Walsh, TJ 2002Defining opportunistic invasive fungal infections in immunocompromised patients with cancer and hematopoietic stem cell transplants: An international consensusClin Inf Dis34714CrossRefGoogle Scholar
- 3.Becker, MJ, Marie, S, Willemse, D, Verbrugh, HA, Bakker-Woudenberg, IAJM 2000Quantitative galactomannan detection is superior to PCR in diagnosing and monitoring invasive pulmonary aspergillosis in na experimental rat modelJ Clin Microbiol814341438Google Scholar
- 5.Kami, M, Tanaka, Y, Kanda, Y, Ogawa, S, Masumoto, T, Ohtomo, K, Matsumura, T, Saito, T, Machida, U, Kasima, T 2000Computed tomographic of chest, latex agglutination test and plasma (1→3)-β-D–glucan assay inearly diagnosis of invasiv pulmonary aspergillosis: A prospective study of 215 patientsHematologica85745752Google Scholar
- 6.Latgé, JP 1999Aspergillus Fumigatus And AspergillosisRev Clin Microbiol12310350Google Scholar
- 8.Maertens, J, Verhaegen, J, Demuynck, H, Bronck, P, Verhoef, G, Vandenberghe, P, Eldere, JV, Verbist Boogaerts, L M 1999Autopsy-controlled prospective evaluation of serial screening for circulating galactomannan by a sandwich enzyme-linked immunosorbent assay for hematological patients at risk for invasive aspergillosisJ Clin Microbiol3732233228PubMedGoogle Scholar
- 9.Maertens, J, Verhaegen, J, Lagrou, K, Eldere, J, Boogaerts, M 2001Screening for circulating galactomannan as a noninvasive diagnostic tool for invasive aspergillosis in prolonged neutropenic patients and stem cell transplantation recipients: A prospective validationBlood9716041610CrossRefPubMedGoogle Scholar
- 10.Maertens, J, Theunissen, K, Verbeken, E, Lagrou, K, Verhaegen, J, Boogaerts, M, Eldere JV, 2004Prospective clinical evaluation of lower cut-offs for galactomannan detection in adult neutropenic cancer patients and haematological stem cell transplant recipientsBr J Haematol126852860CrossRefPubMedGoogle Scholar
- 14.Pereira CN. Detecção de galactomanana no diagnóstico da aspergilose invasiva em receptores de transplante de medula óssea. São Paulo, 2001. (Dissertação de Mestrado – Faculdade de Medicina da Universidade de São Paulo)Google Scholar
- 16.Ribaud, P, Chastang, C, Latgé, JP, Baffroy-Lafite, L, Parquet, N., Devergie, A., Espérou, H, Sélimi, F, Rocha, V, Derouin, F, Socié, G, Gluckman, E 1999Survival and prognostic factors of invasive aspergillosis after allogeneic bone marrow transplantationClin Inf Dis28322330Google Scholar
- 20.Sulahian, A, Boutboul, F, Ribaud, P, Leblanc, T, Lacroix, C, Derouin, F 2001Value of antigen detection using an enzyme immunoassay in the diagnosis and prediction of invasive aspergillosis in two adult and pediatric hematology units during a 4-years prospective studyCancer9311318CrossRefGoogle Scholar