Galactomannan detection for invasive aspergillosis in immunocompromized patients

Leeflang, Mariska; Debets-Ossenkopp, Yvette J.; Wang, Junfeng; Visser, Caroline E.; Scholten, R. J. P. M.; Hooft, Lotty; Bijlmer, H. A.; Reitsma, Johannes B.; Zhang, Mingming; Bossuyt, Patrick M.; Vandenbroucke-Grauls, Christina M. J. E.

doi:10.1002/14651858.cd007394

Cited by 207 publications

(122 citation statements)

References 145 publications

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“…Development of tests not based on cultures, such as the galactomannan assay (GM assay), (1R3)-b-D-glucan assay (G assay) and PCR has received significant attention from researchers. Meta-analyses have shown a sensitivity of 0.78, 0.77 and 0.75 and a specificity of 0.81, 0.83 and 0.87 for the GM assay, G assay and PCR, respectively, using serum (Leeflang et al, 2008;Mengoli et al, 2009;Onishi et al, 2012). Despite their wide usage, these tests have limitations, such as time and equipment requirements as well as the occurrence of significant performance variation.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic accuracy of a novel lateral-flow device in invasive aspergillosis: a meta-analysis

Pan

Zhang

et al. 2015

Journal of Medical Microbiology

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A novel lateral-flow device (LFD) has been invented for use as a diagnostic tool for invasive aspergillosis (IA). We conducted a meta-analysis to assess the diagnostic accuracy of the device. Published studies that used the European Organization for Research and Treatment of Cancer/Mycoses Study Group criteria and provided sufficient data were included. Two reviewers independently collected the data from each study and assessed the risk bias using the Quality Assessment of Diagnostic Accuracy Studies-2. The pooled sensitivity, specificity and diagnostic odds ratio (DOR) were computed and reported with a 95 % confidence interval 90 (95 % CI,) in the LFD test using serum. We concluded that the Aspergillus LFD had a good diagnostic value in immunocompromised patients at risk of IA. The BAL LFD might have a better performance than the serum LFD test.

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Section: Introductionmentioning

confidence: 99%

Diagnostic accuracy of a novel lateral-flow device in invasive aspergillosis: a meta-analysis

Pan

Zhang

et al. 2015

Journal of Medical Microbiology

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“…61,62 With respect to serum BDG and GM assays, several meta-analyses have noted heterogeneity of results attributed to differences in study design, patient populations (e.g., hematologic vs other), the criteria used to define a positive test, and the definition of IA. [63][64][65][66][67][68] Among highrisk patients with hematologic malignancies and chemotherapy-induced neutropenia or allogeneic HCT, both tests share a similar sensitivity of 60%-80% and specificity of 90% and higher. 69 There may also be a role for combining serum BDG and GM screening in high-risk neutropenic patients.…”

Section: Improving Diagnosis Of Invasive Aspergillosismentioning

confidence: 99%

Antifungal stewardship considerations for adults and pediatrics

2016

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Antifungal stewardship refers to coordinated interventions to monitor and direct the appropriate use of antifungal agents in order to achieve the best clinical outcomes and minimize selective pressure and adverse events. Antifungal utilization has steadily risen over time in concert with the increase in number of immunocompromised adults and children at risk for invasive fungal infections (IFI). Challenges in diagnosing IFI often lead to delays in treatment and poorer outcomes. There are also emerging data linking prior antifungal exposure and suboptimal dosing to the emergence of antifungal resistance, particularly for Candida. Antimicrobial stewardship programs can take a multi-pronged bundle approach to ensure suitable prescribing of antifungals via postprescription review and feedback and/or prior authorization. Institutional guidelines can also be developed to guide diagnostic testing in at-risk populations; appropriate choice, dose, and duration of antifungal agent; therapeutic drug monitoring; and opportunities for de-escalation and intravenous-to-oral conversion.

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“…Assays that detect fungal antigens such as GM by enzyme-linked immunosorbent assay (GM assay) or Aspergillus DNA by polymerase chain reaction (PCR) are emerging diagnostic methods; however, their specificity and sensitivity require additional characterization and refinement. The sensitivity of the GM assay ranges from 60% to 100% for infected Aspergillus samples, and the specificity ranges from 80% to 100% [10][11][12][13][14]. The cut-off value has a significant impact on diagnosis because of cross-reactivity [8,12,[15][16][17].…”

Section: Introductionmentioning

confidence: 99%

The Effect Analysis of Different Experimental Methods for the Diagnosis of Invasive Pulmonary Aspergillosis in a Rat Model

Lin¹,

Xu²,

Li³

et al. 2013

IJCM

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Background: Consensus on the most reliable assays to detect invasive aspergillosis from minimally or noninvasive samples has not been reached. In this study, we compared the efficacy of an enzyme-linked immunosorbent assay (ELISA) for galactomannan (GM) detection and quantitative real-time PCR assay (qRT-PCR) for the diagnosis of invasive pulmonary aspergillosis in a rat model. Methods: Neutropenic, male Sprague-Dawley rats (specific pathogen free; 8 weeks old; weight, 200 ± 20 g) were immunosuppressed with cyclophosphamide and infected with Aspergillus fumigatus intratracheally. Tissue and whole blood samples were harvested on days 1, 3, 5, and 7 post-infection and examined with GM ELISA and qRT-PCR. Results: On day 7, A. fumigatus DNA was amplified from 14 of 48 whole blood samples from immunosuppressed infected rats: day 1 (0/12), day 3 (0/12), day 5 (6/12), day 7 (8/12) post infection. The sensitivity and specificity of the qRT-PCR assay were 29.2% and 100%, respectively. Receiver operating characteristic curve (ROC) analysis indicated a Ct cut-off value of 15.35, and the area under the curve (AUC) was 0.627. The GM assay detected antigen in sera obtained on day 1 (5/12), day 3 (9/12), day 5 (12/12), and day 7 (12/12) post-infection, and thus had a sensitivity of 79.2% and a specificity of 100%. The ROC of the GM assay indicated that the optimal cut-off value was 1.40 (specificity, 100%; AUC, 0.919). Conclusions: The GM assay was more sensitive than qRT-PCR assay in diagnosing invasive pulmonary aspergillosis in rats.

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Galactomannan detection for invasive aspergillosis in immunocompromized patients

Cited by 207 publications

References 145 publications

Diagnostic accuracy of a novel lateral-flow device in invasive aspergillosis: a meta-analysis

Diagnostic accuracy of a novel lateral-flow device in invasive aspergillosis: a meta-analysis

Antifungal stewardship considerations for adults and pediatrics

The Effect Analysis of Different Experimental Methods for the Diagnosis of Invasive Pulmonary Aspergillosis in a Rat Model

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