Earlier Diagnosis of Invasive Fusariosis with Aspergillus Serum Galactomannan Testing

Abstract

Cross-reactivity of Fusarium species with serum galactomannan antigen (GMI) test has been observed. We sought to evaluate if GMI could help to early diagnose invasive fusariosis and to monitor treatment response. We reviewed the records of all patients with invasive fusariosis between 2008 and 2012 in three Brazilian hospitals. We selected patients who had at least 1 GMI test within 2 days before or after the date of the first clinical manifestation of fusariosis, and analyzed the temporal relationship between the first positive GMI test and the date of the diagnosis of invasive fusariosis, and the kinetics of GMI in relation to patients' response to treatment. We also selected 18 controls to determine the sensitivity and specificity of the test. Among 18 patients, 15 (83%) had at least one positive GMI (median 4, range 1–15). The sensitivity and specificity of was 83% and 67%, respectively. GMI was positive before the diagnosis of invasive fusariosis in 11 of the 15 cases (73%), at a median of 10 days (range 3–39), and after the diagnosis in 4 cases. GMI became negative in 8 of the 15 patients; 3 of these 8 patients (37.5%) were alive 90 days after the diagnosis of fusariosis compared with 2 of 7 (29%) who did not normalize GMI (p = 1.0). GMI is frequently positive in invasive fusariosis, and becomes positive before diagnosis in most patients. These findings may have important implications for the choice of antifungal therapy in settings with high prevalence of invasive fusariosis.

How we treat invasive fungal diseases in patients with acute leukemia: the importance of an individualized approach

“…The test is also diagnostic in other IMIs such as fusariosis (sensitivity and specificity of 83% and 67%, respectively). 78 We do not consider this result a false positive but a true positive for an IMI, which can be differentiated from IA by its distinguishing clinical and laboratory findings.…”

“…Blood cultures have moderate sensitivity for hematogenous infections with yeasts 77 and molds with adventitious sporulation 78 but have no sensitivity for IA. 19 Cultures, stains, and histopathology with direct examination of involved sites can be diagnostic (eg, metastatic skin lesions of candidiasis, trichosporonosis, 79 and fusariosis).…”

Use of Fungal Diagnostics and Therapy in Pediatric Cancer Patients in Resource-Limited Settings

“…Its positive predictive value has been challenged by reports of false-positive results in patients receiving certain beta-lactam antibiotics, depending on the cutoffs used [57], and sensitivity is markedly reduced in settings where mold-active antifungal agents are used prophylactically [78, 87]. A retrospective study in pediatric patients at three hospitals in Brazil also found that serum galactomannan was positive in 15 of 18 patients with invasive Fusarium infection [88]. …”

Performance of 1,3‐beta‐D‐glucan in the diagnosis and monitoring of invasive fusariosis

“…We have previously reported a series of 15 out of 18 patients with invasive fusariosis who presented with positive serum galactomannan. The test was positive before the first clinical manifestation of fusariosis in the majority of cases, suggesting that a fungal biomarker could be of help in establishing the diagnosis of invasive fusariosis at an earlier disease stage …”