<i>Aspergillus</i>
            Galactomannan Antigen in the Cerebrospinal Fluid of Bone Marrow Transplant Recipients with Probable Cerebral Aspergillosis

Viscoli, Claudio; Machetti, Marco; Gazzola, Paola; Maria, Andrea De; Paola, Dimitri; Lint, Maria Teresa Van; Gualandi, Francesca; Truini, Mauro; Bacigalupo, Andrea

doi:10.1128/jcm.40.4.1496-1499.2002

Cited by 140 publications

(71 citation statements)

References 18 publications

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“…In a recent report, Bonatti et al found positive Aspergillus PCR signals in pleural fluid samples from four patients with culturally proven Aspergillus empyema (22). These findings suggest that analyzing pleural fluid for biomarkers such as Aspergillus PCR results might be useful, as has been seen for cerebrospinal fluid (12,32); however, our data show a lower sensitivity for effusion samples than for tissue samples, representing a possible sample error as a dilution effect might by present.…”

Section: Discussioncontrasting

confidence: 54%

Aspergillus PCR-Based Investigation of Fresh Tissue and Effusion Samples in Patients with Suspected Invasive Aspergillosis Enhances Diagnostic Capabilities

et al. 2013

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Although it is a severe complication in immunocompromised patients, diagnosing invasive fungal disease (IFD), especially invasive aspergillosis (IA), remains difficult. In certain clinical scenarios, examining tissue samples for identification of the infectious organism becomes important. As culture-based methods rarely yield results, the performance of an Aspergillus-specific nested PCR in fresh tissue or pleural effusion samples was evaluated. Fresh tissue (n ‫؍‬ 59) and effusion (n ‫؍‬ 47) specimens from 79 immunocompromised patients were subjected to an Aspergillus-specific PCR assay. Twenty-six patients had proven (n ‫؍‬ 20 , 65% to 95%) and 100% (95% CI, 86% to 100%), respectively, thus leading to a diagnostic odds ratio of >200. In this analysis, good diagnostic performance of the PCR assay for detection of IA was observed for tissue samples, while effusion samples showed lower sensitivity rates. PCR testing represents a complementary tool; a positive PCR result strengthens the likelihood of IA, whereas IA seems unlikely in cases with negative results but findings could indicate nonAspergillus IFD. Thus, PCR testing of these specimens enhances the diagnostic capabilities.

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Section: Discussioncontrasting

confidence: 54%

Aspergillus PCR-Based Investigation of Fresh Tissue and Effusion Samples in Patients with Suspected Invasive Aspergillosis Enhances Diagnostic Capabilities

et al. 2013

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“…A study [110] with a small number of patients suggested it might be diagnostic for high-risk patients with compatible neurological symptoms. Further studies on larger patient populations are necessary fully to evaluate the role of this test in the diagnosis of neurological aspergillosis.…”

Section: Diagnosismentioning

confidence: 99%

Pulmonary aspergillosis: a clinical review

Kousha¹,

Tadi²,

Soubani³

2011

Eur Respir Rev

583

596

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Aspergillus is a mould which may lead to a variety of infectious, allergic diseases depending on the host's immune status or pulmonary structure. Invasive pulmonary aspergillosis occurs primarily in patients with severe immunodeficiency. The significance of this infection has dramatically increased with growing numbers of patients with impaired immune state associated with the management of malignancy, organ transplantation, autoimmune and inflammatory conditions; critically ill patients and those with chronic obstructive pulmonary disease appear to be at an increased risk. The introduction of new noninvasive tests, combined with more effective and better-tolerated antifungal agents, has resulted in lower mortality rates associated with this infection. Chronic necrotising aspergillosis is a locally invasive disease described in patients with chronic lung disease or mild immunodeficiency. Aspergilloma is usually found in patients with previously formed cavities in the lung, whereas allergic bronchopulmonary aspergillosis, a hypersensitivity reaction to Aspergillus antigens, is generally seen in patients with atopy, asthma or cystic fibrosis. This review provides an update on the evolving epidemiology and risk factors of the major manifestations of Aspergillus lung disease and the clinical manifestations that should prompt the clinician to consider these conditions. Current approaches for the diagnosis and management of these syndromes are discussed.

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“…To date, only 3 studies including a total of 25 patients have described the value of CSF GM, only 2 of which were carried out with patients with suspected CA (3,6,7). In these 2 studies, CSF GM optical density indexes (ODI) were higher in patients with CA than in those without CA, and sensitivity and specificity were 80% and 100% (6,7). Based on these limited data, the GM antigen test in CSF seems promising, even though no positive and negative predictive values (PPV and NPV) were determined and no formal cutoff was established.…”

mentioning

confidence: 99%

Diagnostic Performance of Galactomannan Antigen Testing in Cerebrospinal Fluid

et al. 2016

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e Testing cerebrospinal fluid (CSF) for the presence of galactomannan (GM) antigen may help in diagnosing cerebral aspergillosis (CA). However, the use of the CSF GM test as a diagnostic test has been little studied. We evaluated its diagnostic performance by comparing the CSF GM optical density indexes (ODI) at different cutoffs in patients with probable and proven CA to those in patients without CA. Patients from 2 tertiary referral hospitals with suspected CA between 2004 and 2014 and in whom CSF GM ODI had been determined were selected. European Organization for Research and Treatment of Cancer/Invasive Infectious Diseases Study Mycoses Group (EORTC/MSG) definitions of invasive aspergillosis and CA were used, but with the exclusion of the test to be validated (i.e., the CSF GM test) as a microbiological EORTC/MSG criterion. The study population consisted of 44 patients (4 with proven CA, 13 with probable CA, and 27 with no CA). Of the 17 patients with CA, 15 had a CSF GM ODI of >2.0. Of 27 patients without CA, 26 had a CSF GM ODI of <0.5 and 1 had a CSF GM ODI of 8.2. When a GM CSF ODI cutoff of 1.0 was used, the sensitivity, specificity, and positive and negative predictive values were 88.2%, 96.3%, 93.8%, and 92.9%, respectively. The same results were found when a CSF GM ODI cutoff of 0.5 or 2.0 was used. Testing GM in CSF has a high diagnostic performance for diagnosing CA and may be useful to diagnose or virtually rule out the infection without the need for a cerebral biopsy. C erebral aspergillosis (CA) is a rare and often fatal invasive fungal disease (IFD) (1, 2). The diagnosis is challenging, as radiological findings are nonspecific and cerebrospinal fluid (CSF) cultures are positive only in less than one-third of cases (3, 4). Moreover, obtaining brain tissue for histopathological examination, the diagnostic gold standard, is frequently not feasible. Galactomannan (GM) antigen detection in CSF is one of the microbiological criteria in the revised European Organization for Research and Treatment of Cancer/Invasive Infectious Diseases Study Mycoses Group (EORTC/MSG) criteria (5). However, its diagnostic performance has been studied very little. To date, only 3 studies including a total of 25 patients have described the value of CSF GM, only 2 of which were carried out with patients with suspected CA (3, 6, 7). In these 2 studies, CSF GM optical density indexes (ODI) were higher in patients with CA than in those without CA, and sensitivity and specificity were 80% and 100% (6, 7). Based on these limited data, the GM antigen test in CSF seems promising, even though no positive and negative predictive values (PPV and NPV) were determined and no formal cutoff was established. This study evaluated the diagnostic performance of the Platelia GM antigen test (Bio-Rad, Marnes-la-Coquette) in CSF of patients with suspected CA.(This information was presented at the 7th Trends in Medical Mycology, Lisbon, Portugal, 9 to 12 October 2015 [8].) MATERIALS AND METHODSThis retrospective study was performed at the Erasm...

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Aspergillus Galactomannan Antigen in the Cerebrospinal Fluid of Bone Marrow Transplant Recipients with Probable Cerebral Aspergillosis

Cited by 140 publications

References 18 publications

Aspergillus PCR-Based Investigation of Fresh Tissue and Effusion Samples in Patients with Suspected Invasive Aspergillosis Enhances Diagnostic Capabilities

Aspergillus PCR-Based Investigation of Fresh Tissue and Effusion Samples in Patients with Suspected Invasive Aspergillosis Enhances Diagnostic Capabilities

Pulmonary aspergillosis: a clinical review

Diagnostic Performance of Galactomannan Antigen Testing in Cerebrospinal Fluid

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