Correlation between high-resolution computed tomography and galactomannan antigenemia in adult hematologic patients at risk for invasive aspergillosis

Hidalgo, Alberto; Parody, Rocío; Martino, Rodrigo; Sánchez, Francisco Alberto García; Franquet, Tomás; Giménez, A.; Blancas, C.

doi:10.1016/j.ejrad.2008.03.026

Cited by 29 publications

(18 citation statements)

References 26 publications

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“…Although bronchoscopy is an "invasive" procedure for obtaining specimens (42), BAL is a direct sampling of the affected organ and is therefore important in the diagnosis of pulmonary fungal infections (22). Rationally, detection of fungal markers in the lungs (i.e., at the site of the disease) might be more sensitive than that in the serum (4), and in particular, serum GM levels may be lower in patients with airway IA than in those with angioinvasive aspergillosis (16). Also, Aspergillus DNAemia is probably only transient, and the most suitable time point for blood sampling for PCR has yet to be defined (18).…”

Section: Discussionmentioning

confidence: 99%

Diagnosis of Invasive Aspergillosis by a Commercial Real-Time PCR Assay for Aspergillus DNA in Bronchoalveolar Lavage Fluid Samples from High-Risk Patients Compared to a Galactomannan Enzyme Immunoassay

Torelli¹,

Sanguinetti²,

Moody

et al. 2011

J Clin Microbiol

119

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Culture-independent molecular techniques such as real-time PCRs offer the potential for early diagnosis of invasive aspergillosis (IA), thereby reducing the disease-associated mortality rate. PCR-based testing is presently excluded from disease-defining consensus criteria due to lack of standardization and clinical validation. A single-center prospective study was conducted to investigate the performance of the commercially available MycAssay Aspergillus test for detecting Aspergillus DNA in patients with suspicion of IA. To this end, a total of 158 bronchoalveolar lavage (BAL) fluid specimens that were consecutively collected from hematology (n ‫؍‬ 68) and intensive care unit (n ‫؍‬ 90) patients were examined. Sixteen of 17 (94.1%) specimens from patients with proven/probable IA were MycAssay positive, and 15 of these 16 patients were also positive by an "in-house" PCR assay. A total of 139 of 141 (98.6%) specimens from patients without proven/probable IA were MycAssay negative. Fifteen of 16 (94.1%) MycAssay-positive patients were also positive for BAL fluid galactomannan (GM) at an index cutoff of >1.0 (index range, 1.1 to 8.3), as were 3 patients without IA but with pulmonary fusariosis. Interestingly, in seven of the PCR-positive BAL specimens that tested culture positive for Aspergillus species, cycle threshold values were earlier than those of specimens with a culture-negative result. In conclusion, the MycAssay Aspergillus PCR appears to be a sensitive and specific molecular test for the diagnosis of IA, and its performance is comparable to that of the GM assay. However, more large studies are necessary to firmly establish its clinical utility in high-risk settings.

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Section: Discussionmentioning

confidence: 99%

Diagnosis of Invasive Aspergillosis by a Commercial Real-Time PCR Assay for Aspergillus DNA in Bronchoalveolar Lavage Fluid Samples from High-Risk Patients Compared to a Galactomannan Enzyme Immunoassay

Torelli¹,

Sanguinetti²,

Moody

et al. 2011

J Clin Microbiol

119

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“…Empirical antifungal therapy with anti-mold active agents was started in patients with persistent or recurrent fever of unknown origin (472 h) and a thoracic computerized tomography (CT) scan was carried out, as reported earlier. 12 Patients with GVHD and a febrile illness or respiratory symptoms not resolving with antibiotics were also routinely studied with a chest CT since 1995, and the routine study of the galactomannan (GM) Platelia assay (Bio-Rad Laboratories, Marres la Coquette, France) in blood samples since 2003, with a maximum of three times per week in inpatients and at each visit in outpatients. Respiratory samples were also always studied by fungal-directed cytological stains and fungal cultures.…”

Section: Conditioning Regimen and Graft-vs-host Disease (Gvhd) Prophymentioning

confidence: 99%

“…Suggestive radiological findings included the presence of nodules with the halo sign during neutropenia or cavitated nodules after neutrophil recovery on the chest X-ray or CT scan. 12 Respiratory virus (RV) infections. A URTI was defined as the new onset of nasal, pharyngeal or laryngeal irritation with isolation of an RV in an NPA.…”

Section: Conditioning Regimen and Graft-vs-host Disease (Gvhd) Prophymentioning

confidence: 99%

Lower respiratory tract respiratory virus infections increase the risk of invasive aspergillosis after a reduced-intensity allogeneic hematopoietic SCT

Martino

Piñana

Parody

et al. 2009

Bone Marrow Transplant

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We have analyzed the incidence and risk factors for the occurrence of invasive aspergillosis (IA) among 219 consecutive recipients of an allogeneic hematopoietic SCT after a reduced-intensity conditioning regimen (Allo-RIC). Twenty-seven patients developed an IA at a median of 218 days (range 24-2051) post-Allo-RIC, for a 4-year incidence of 13% (95% confidence interval 4-24%). In multivariate analysis, risk factors for developing IA were steroid therapy for moderate-to-severe graft vs host disease (GVHD) (Hazard Ratio (HR) 2.9, P=0.03), occurrence of a lower respiratory tract infection (LRTI) by a respiratory virus (RV) (HR 4.3, P<0.01) and CMV disease (HR 2.8, P=0.03). Variables that decreased survival after Allo-RIC were advanced disease phase (HR 1.9, P=0.02), steroid therapy for moderate-to-severe GVHD (HR 2.2, P<0.01), not developing chronic GVHD (HR 4.3, P<0.01), occurrence of LRTI by an RV (HR 3.4, P<0.01) and CMV disease (HR 2, P=0.01), whereas occurrence of IA had no effect on survival (P=0.5). Our results show that IA is a common infectious complication after an Allo-RIC, which occurs late post-transplant and may not have a strong effect on survival. An important observation is the possible role of LRTI by conventional RVs as risk factors for IA.

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“…Being an early indicator of disease, antigen can be detected in blood before clinical or radiologic features of disease appear [9]. However, serum GM levels may be lower in patients with airway aspergillosis than in those with angioinvasive IA [10]. In addition, low values and false-negative results are seen more often in moderately neutropenic and non-neutropenic patients as opposed to severely granulocytopenic patients [11].…”

Section: Introductionmentioning

confidence: 91%

Galactomannan detection in nonserum specimens: Where do we stand?

Vlieger¹,

Lagrou²,

Meersseman³

2009

Curr Fungal Infect Rep

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Correlation between high-resolution computed tomography and galactomannan antigenemia in adult hematologic patients at risk for invasive aspergillosis

Cited by 29 publications

References 26 publications

Diagnosis of Invasive Aspergillosis by a Commercial Real-Time PCR Assay for Aspergillus DNA in Bronchoalveolar Lavage Fluid Samples from High-Risk Patients Compared to a Galactomannan Enzyme Immunoassay

Diagnosis of Invasive Aspergillosis by a Commercial Real-Time PCR Assay for Aspergillus DNA in Bronchoalveolar Lavage Fluid Samples from High-Risk Patients Compared to a Galactomannan Enzyme Immunoassay

Lower respiratory tract respiratory virus infections increase the risk of invasive aspergillosis after a reduced-intensity allogeneic hematopoietic SCT

Galactomannan detection in nonserum specimens: Where do we stand?

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