At the bone marrow transplantation center of the San Martino Hospital (Genoa), we observed an increase in the rate of patients with positive Platelia Aspergillus (PA; Bio-Rad) test results, from 10% (38 of 386 patients) in the period from January 1999 through January 2003 to 36% (21 of 59 patients) in the period from February 2003 through May 2003. Positivity was significantly (P<.001) associated with the administration of piperacillin-tazobactam (PT) (17 [74%] of 23 patients who received PT had positive results vs. 4 [11%] of 36 who did not receive PT). Multivariate analysis found administration of PT ( chi 2=34.7; P<.001) and underlying disease ( chi 2=21.14; P<.001) to be associated with PA positivity. Of 15 PT batches tested, 12 had positive PA test results.
Determinations of the type and setting of empirical therapy for immunocompromised patients with fever are complicated by the characteristics of the underlying illness and the effects of treatments already received, as well as by changing microbiological patterns and trends in drug resistance at national and institutional levels. Several systems have been proposed to distinguish patients who could benefit from outpatient antibiotic therapy from patients who require hospitalization. Practical considerations may decide whether the necessary monitoring during the period of neutropenia can be achieved.
The Aspergillus galactomannan test was performed on cerebrospinal fluid and serum samples from 5 patients with probable cerebral aspergillosis and from 16 control patients. Cerebrospinal fluid galactomannan levels were significantly higher in aspergillosis patients, and most galactomannan was produced intrathecally. Comparison of serum galactomannan values in pulmonary and cerebral aspergillosis patients showed significant overlapping. Detection of Aspergillus galactomannan in cerebrospinal fluid may be diagnostic of cerebral aspergillosis.
Summary:The performance of two Aspergillus antigenemia systems, the sandwich enzyme-linked immunosorbent assay (ELISA), Platelia Aspergillus test, and the latex agglutination (LA), Pastorex Aspergillus test, in the diagnosis of invasive aspergillosis were compared by testing 364 serum samples from 22 bone marrow transplant (BMT) recipients. Sensitivity and specificity for the ELISA test were 60% and 82% respectively, vs 40% and 94% for the LA test. In the two patients found positive with both methods, the ELISA test became positive earlier than the LA test or remained positive after the LA test had become negative. These results encourage further evaluation of the Platelia Aspergillus test, to assess its role in the management of invasive aspergillosis in BMT patients. Keywords: invasive aspergillosis; galactomannan; antigen detectionIn recent years, considerable progress has been achieved in the management of bacterial and viral infections in bone marrow transplant (BMT) recipients. By contrast, little progress has been made in the management of fungal infections, especially aspergillosis. 1 This is probably due both to the frequent impossibility of obtaining a reliable diagnosis of aspergillosis at an early stage of the disease and to the relatively poor efficacy of the presently available antifungal armamentarium. As a result, indirect diagnostic methods have received considerable attention in order to overcome these limitations. So far, no method has proven sufficiently sensitive and specific to allow a diagnosis of aspergillosis at an early stage. 2 However, several authors have pointed out that this might be due, at least in part, to how the tests have been used in clinical practice and to the criteria adopted by clinicians in the interpretation of results. 2 A precommercial version of a sandwich enzymelinked immunosorbent assay (ELISA) for detection of cirCorrespondence: C Viscoli, Unità di Malattie dell'Ospite Compromesso, Istituto Nazionale per la Ricerca sul Cancro-Genova, Largo Rosanna Benzi, 10-16132 Genova, Italy Received 22 May 1997; accepted 17 December 1997 culating galactomannan, a polysaccharide component of the fungal cell wall, has been recently described. 3 The test employs the same monoclonal antibody (MoAb) EB-A2 used in the latex agglutination (LA) test (Pastorex Aspergillus; Sanofi Diagnostic, Pasteur, France), but the ELISA system detects galactomannan in serum at a concentration of 1 ng/ml, whereas the LA test has a 15 ng/ml threshold.We have compared sensitivity and specificity of the new ELISA detection system with that of the LA system in the diagnosis of invasive aspergillosis in BMT patients. With the aim of improving the sensitivity and the specificity of the tests, we prospectively collected consecutive serum samples in patients at high risk of aspergillosis, regardless of the presence or absence of clinical symptoms. Patients and methodsDuring a 6-month period, 22 allogeneic BMTs from matched donors, followed at the Bone Marrow Transplant Unit of the Haematology Department of S...
In recent years, several reports have underlined the increasing role of fungal infections as a cause of morbidity and mortality in hospitalised patients. For this reason, and also in light of the high mortality rate associated with these infections, chemoprophylaxis has been advocated by several authors. The available evidence suggests that both fluconazole and itraconazole are able to decrease candida colonisation and infection, when compared with placebo or with nonabsorbable antifungals. Data seem also to suggest that a decrease in fungus-related mortality can be achieved with prophylaxis, although with little effect on overall mortality, probably because of the importance of severe underlying diseases. Itraconazole proved to be effective in the prevention of fungal infections, including invasive aspergillosis, although with increased incidence of side-effects, often leading to treatment discontinuation. The other side of the coin is that antifungal prophylaxis might have untoward effects, such as the selection of triazole-resistant Candida strains or the induction of resistance. In addition, some authors have suggested that the use of triazoles might modulate the pattern of infecting organisms in cancer patients, increasing the risk of both aspergillosis and bacteremia. In conclusion, antifungal prophylaxis with triazole antifungals should be used with caution, only in patients at high risk for invasive fungal infections. These include allogeneic bone marrow transplant patients (especially those with mismatched or unrelated donors), acute myeloid leukaemia patients treated with high-dose cytarabine (C-ara), very-low-birth-weight infants, patients with chronic granulomatous disease, and high-risk surgical and intensive-care unit patients.
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