Galactomannan Assay and Invasive Pulmonary Aspergillosis - Comparison of the Test Performance at an in-house and the Kit Cut-off

Savio, Jayanthi; Menon, N.; Sudharma, Arun Ramachandran; Mathew, J.L.

doi:10.7860/jcdr/2016/19175.8310

Cited by 5 publications

(3 citation statements)

References 12 publications

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“…This study has several limitations. First, the GM assay is broadly accepted as a valuable tool for the diagnosis of patients with IPA ( 25 , 26 ), including patients in the ICU ( 27 ). Additionally, the GM samples from the BALF were more than GM samples from the serum ( 28 ).…”

Section: Discussionmentioning

confidence: 99%

Clinical Characteristics and Prognostic Risk Factors of Patients With Proven Invasive Pulmonary Aspergillosis: A Single-Institution Retrospective Study

et al. 2021

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Background: The mortality and burden of medical costs associated with invasive pulmonary aspergillosis (IPA) is very high. Currently, the clinical features and prognostic factors of patients with proven IPA are not very clear, especially in the Chinese population. In this retrospective analysis, we aimed to identify the clinical features and prognostic factors of patients with proven IPA.Methods: The diagnostic criteria for proven IPA were based on the international consensus of the EORTC/MSG. Data of patients with proven IPA at the West China Hospital of Sichuan University between January 2012 and December 2018 were collected. The optimal cut-off value of continuous variables was determined by Receiver Operating Characteristic curve and maximum Youden's index. Finally, using the Cox regression analysis to identify correlations between the clinical parameters associated with morbidity.Results: A total of 117 patients with proven IPA were included in the study, and 32 (27.4%) patients died during the follow-up period. Compared with the survivor group, elderly, patients with comorbidities, and patients undergoing chemotherapy and the level of inflammatory biomarkers [erythrocyte sedimentation rate, platelet count, interleukin-6, C-reactive protein (CRP)] in the non-survivor group were higher, while the albumin level was lower (P = 0.018). The imaging features were consolidation, nodules, cavities, pleural effusion, ground-glass shadows, and halo signs in order. Overall, 41.0% patients had mixed imaging features. The results suggested the most appropriate cut-off value of age and CRP were 60 years and 14.1 mg/L, respectively. The multivariate Cox regression analysis suggested that advanced age (>60 years) [hazard ratio (HR): 10.7, confidence interval (CI): 2.5–44.9, P < 0.001), undergoing chemotherapy (HR: 9.5, CI: 2.7–32.9, P < 0.001), presence of pleural effusion (HR: 5.74, CI: 1.6–20.8, P = 0.008), and increased CRP levels (>14.1 mg/L) (HR: 6.3, CI: 1.2–34.3, P = 0.033) were risk factors for all-cause mortality in patients with proven aspergillosis.Conclusions: This study showed that the prognosis of proven IPA is poor, and the age >60 years, undergoing chemotherapy, pleural effusion on CT image, and CRP levels >14.1 mg/L may be as risk factors for mortality in patients with proven IPA. large samples and real-world studies are needed to confirm these results in the future.

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Section: Discussionmentioning

confidence: 99%

Clinical Characteristics and Prognostic Risk Factors of Patients With Proven Invasive Pulmonary Aspergillosis: A Single-Institution Retrospective Study

et al. 2021

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“…[21] One of the Indian study done by Savio et al from Bangalore suggested a cut off value of 0.52 instead of 0.5. In this study with 0.52 cut off they found sensitivity, specificity, PPV and NPV as 75%, 79%, 76%, 82%, however the patients whom they have included were mostly non cancer adult patients [22]. Review done by Mycoses study group also suggests a cut off of 0.5 in consecutive samples.…”

Section: Discussionmentioning

confidence: 99%

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2017

RJLBPCS

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Introduction: Invasive Aspergillosis (IA) can cause significant morbidity and mortality in pediatric cancer patients. The Galactomannan enzyme immunoassay (GM-EIA) has shown promising results to diagnose IA in adult patients. But data on this assay in children are limited by small sample size and conflicting results. We evaluated GM-EIA at different cut off in pediatric cancer patients on chemotherapy with fever and neutropenia and not responding to broad spectrum antibiotics for four days. Aim: To Evaluate Galactomannan at different cut off values in 200 pediatric cancer patients. Materials and Methods: It is a hospital based cross sectional cohort study in pediatric cancer patients. Serum specimens were collected either once or twice weekly, during neutropenic periods. Operating characteristics were calculated using the GM-EIA index values (IV) of 0.5, 0.7. 1.0 & 1.5 in serum samples. Results: 232 serum samples from 200 febrile neutropenic patients were available for evaluation. Of these 232 samples 168 samples were single samples and 32 were consecutive samples (received twice in a week). GM assay was evaluated in both single and consecutive samples at different cut off IV. For single sample the best cut off IV was found to be 1.5 IV. Sensitivity, specificity, PPV, NPV, PLR and NLR at 1. 5 IV were: 78, 86, 79, 83, 4.83, and 0.20 respectively. For consecutive samples the best cut off IV was found to be 0.5 at which the sensitivity, specificity, PPV, NPV, PLR and NLR were: 84.2, 86.46, 83.73, 85.50,5.82 and 0.18 respectively. Conclusion:Role of single sample cannot be ruled out in establishing the diagnosis of IA in pediatric cancer patients especially in resource poor settings where frequent sampling is not possible. The best cut off IV of GM for diagnosis of IA in pediatric cancer patients in single serum sample is 1.5 and in consecutive sample is 0.5. MATERIALS AND METHODSThe study collection and stored at -20°C until analysis.2-3 ml of blood were collected in pediatric biphasic blood culture bottle prior to the administration of antimicrobials and were incubated aerobically at 37˚C and checked every day up to 7 days and then twice a week for up to 4 weeks, unless evidence of microbial growth was observed, subculture was done on Sabouraud's dextrose agar (SDA) plates, and incubated at 37°C and 25°C. The blood cultures were considered as negative after four weeks of incubation.[10]. GM levels in serum was measured by using Platelia Aspergillus enzyme immunoassay test (Bio Rad, Platelia, Marnes, La Coquette, France) as per the manufacturer instructions. Results were recorded as indexes relative to the mean OD of the threshold controls. Samples that had GM IV of ≥ 0.5 were considered as positive. Second samples of the patients were considered as independent episode if it was received after 4 week apart from the previous one, with the patient becoming clinically well between this duration. All these samples were also evaluated at 0.7, 1.0 and 1.5 IV.Decision for the start of antifungal prophylaxis...

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“…Invasive aspergillosis (IA) is one of the most significant and challenging invasive fungal infections, and is a major cause of morbidity and mortality in high-risk patients [1,2]. This disease occurs mainly in patients with a markedly impaired immune system.…”

Section: Introductionmentioning

confidence: 99%

Effect of involved Aspergillus species on galactomannan in bronchoalveolar lavage of patients with invasive aspergillosis

Armaki

Hedayati

Moqarabzadeh

et al. 2017

Journal of Medical Microbiology

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Purpose. The detection of galactomannan (GM) in bronchoalveolar lavage (BAL) fluid is an important surrogate marker for the early diagnosis and therapeutic monitoring of invasive aspergillosis (IA), regardless of the involved species of Aspergillus. Here, we utilized the Platelia Aspergillus GM enzyme immunoassay (Bio-Rad) to evaluate the GM index in BAL fluid samples from patients with proven, probable or putative IA due to Aspergillusflavus versus Aspergillusfumigatus.Methodology. In a prospective study between 2009 and 2015, 116 BAL samples were collected from suspected IA patients referred to two university hospitals in Tehran, Iran.Key findings. According to European Organization for Research and Treatment of Cancer and Mycoses Study Group and Blot criteria, 35 patients were classified as IA patients, of which 33 cases tested positive for GM above 0.5 and, among these patients, 22 had a GM index !1. Twenty-eight were culture positive for A. flavus and seven for A. fumigatus. The GM index for A. flavus cases was between 0.5-6.5 and those of A. fumigatus ranged from 1 to 6.5. The sensitivity and specificity of a GM index !0.5 in cases with A. flavus were 86 and 88 % and for A. fumigatus patients were 100 and 73 %, respectively.Conclusion. Overall, the mean GM index in patients with A. fumigatus (3.1) was significantly higher than those of A. flavus (1.6; P-value=0.031) and the sensitivity of GM lower for A. flavus when compared to A. fumigatus. This finding has implications for diagnosis in hospitals and countries with a high proportion of A. flavus infections.

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Galactomannan Assay and Invasive Pulmonary Aspergillosis - Comparison of the Test Performance at an in-house and the Kit Cut-off

Cited by 5 publications

References 12 publications

Clinical Characteristics and Prognostic Risk Factors of Patients With Proven Invasive Pulmonary Aspergillosis: A Single-Institution Retrospective Study

Clinical Characteristics and Prognostic Risk Factors of Patients With Proven Invasive Pulmonary Aspergillosis: A Single-Institution Retrospective Study

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Effect of involved Aspergillus species on galactomannan in bronchoalveolar lavage of patients with invasive aspergillosis

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