Galactomannan Testing and the Incidence of Invasive Pulmonary Aspergillosis: A 10-Year Nationwide Population-Based Study in Taiwan

Abstract

BackgroundThe clinical impact of the galactomannan (GM) test for the diagnosis of invasive pulmonary aspergillosis (IPA) is controversial. Our study evaluated the incidence and trends of IPA and GM testing in patients with aspergillus infections.MethodsWe conducted a nationwide inpatient population study using the Taiwan National Health Insurance Research Database. A total of 346 IPA (62.14% male) patients from the years 2002 to 2011 were identified for inclusion in the study.ResultsThe average incidence of IPA was 1.51 per million person-years. Over the study period, we observed an increasing trend from 0.94 to 2.06 per million person-years (P < 0.0001). We observed male predominance in IPA incidence (M/F: 1.85/1.15). Both males and females showed significantly increasing trends of IPA incidence over time (0.87 to 4.55 and 0.36 to 2.07 per million person-years for the males and females, respectively). GM testing for IPA significantly increased from 2002 to 2011, and the GM test was utilized more frequently for males than females. The increase in the incidence of IPA might be positively associated with the increase in GM testing over the past decade.ConclusionThe incidence rates of both IPA and GM testing have increased over time. GM testing is recommended for the early diagnosis of patients with suspected aspergillosis.

Tos crónica, sibilancia y disnea: bronquiectasia y aspergilosis

“…In the patient herein described, the diagnosis of CPA was established with some delay because of non-specific manifestations. 4,5 here attributed to bronchiectasis sequels. Moreover, the long standing course of cough, dyspnea and wheezing in association with blood eosinophilia might propitiate the mistaken diagnosis of bronchial asthma episodes.…”

“…[1][2][3][4] Invasive aspergillosis is often late diagnosed and associated with high mortality rate, and pulmonary foci represent the major primary origin of widespread infections. 1,2,5 Since 2002, the incidence of invasive pulmonary aspergillosis has growing, at least partially due to the increased utilization of the galactomannan test for diagnosis. 4,5 Clinical diagnosis of aspergillosis is often challenging and depends on complementary tools.…”

“…1,2,5 Since 2002, the incidence of invasive pulmonary aspergillosis has growing, at least partially due to the increased utilization of the galactomannan test for diagnosis. 4,5 Clinical diagnosis of aspergillosis is often challenging and depends on complementary tools. In the patient herein described, the diagnosis of CPA was established with some delay because of non-specific manifestations.…”

“…1,3 The diagnosis is based on typical pulmonar y images and microscopy or culture evidence of the fungus or positivity of the specific serologic test for Aspergillus. [1][2][3][4][5] Worthy of note is the necessity of excluding diverse alternative causal agents, and pulmonary tuberculosis has been the main differential task in low income regions. 1,3 The aim of this report is enhance the suspicion index about aspergillosis and briefly comment the role of galactomannan test, that may have controversial clinical impact in www.medigraphic.org.mx scattered nodules with attenuation of soft tissue, the most conspicuous (0.8 x 0.7 cm) on the left posterior basal segment; bilateral ground-glass opacity and tree-in-bud images; and multiple bronchiectasis more evident in both bases (figure 1).…”

“…The sensitivity and specificity as well as the cut-off level differ from immunocompetent ones. 1,4,5…”