Usefulness of Sequential Aspergillus galactomannan Antigen Detection Combined With Early Radiologic Evaluation for Diagnosis of Invasive Pulmonary Aspergillosis in Patients Undergoing Allogeneic Stem Cell Transplantation

Busca, Alessandro; Locatelli, Franco; Barbui, Anna Maria; Limerutti, Giorgio; Serra, Roberto; Libertucci, Daniela; Falda, Michele

doi:10.1016/j.transproceed.2006.02.072

Cited by 54 publications

(30 citation statements)

References 12 publications

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“…One of the major limitations of the galactomannan test is the species-specificity of the assay: it is not possible to exclude involvement by other moulds such as Fusarium, Zygomycetes, and dematiaceous fungi [102]. Therefore, galactomannan detection does not remove the need for careful microbiological and clinical evaluations.…”

Section: Diagnosismentioning

confidence: 99%

“…Galactomannan is detected in other body fluids such as BAL, urine, and cerebrospinal fluid (CSF), and there is evidence that these tests may become positive prior to clinical and radiological findings suggestive of IPA [102][103][104][105]. In one study, incorporating galactomannan and quantitative PCR assays into standard BAL fluid analysis appeared to enhance bronchoscopic identification of Aspergillus species as the cause of pulmonary disease in HSCT recipients [103].…”

Section: Diagnosismentioning

confidence: 99%

See 1 more Smart Citation

Pulmonary aspergillosis: a clinical review

Kousha¹,

Tadi²,

Soubani³

2011

Eur Respir Rev

579

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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Section: Diagnosismentioning

confidence: 99%

Section: Diagnosismentioning

confidence: 99%

Pulmonary aspergillosis: a clinical review

Kousha¹,

Tadi²,

Soubani³

2011

Eur Respir Rev

579

596

View full text Add to dashboard Cite

show abstract

“…Use of other samples such as BAL [46,[67][68][69][70][71][72][73] and minced tissues [4] also appears to provide promising results (Table 5). There is evidence that galactomannan may become positive prior to clinical and radiological findings suggestive for IPA [46,[74][75][76]. Amongst HSCT recipients and patients with haematological malignancies, BAL galactomannan testing added to the sensitivity of both BAL culture and serum galactomannan testing [46,76,77].…”

Section: Serology Assaysmentioning

confidence: 99%

Diagnosing Aspergillosis: The Role of Invasive Diagnostic Interventions

Lass‐Flörl

Freund

2009

Aspergillosis: From Diagnosis to Prevention

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The diagnosis of invasive aspergillosis remains challenging and current conventional methods are limited for the diagnosis of invasive fungal infections. The gold-standard for the definite diagnosis of proven invasive pulmonary aspergillosis remains either histopathologic, cytopathologic or direct tissue examination, based on the documentation of typical hyphae and a positive culture of Aspergillus spp. This chapter reviews the yield of invasive procedures in the diagnosis of aspergillosis. Biopsies may be taken percutaneously, bronchoscopically, via open surgery or video-assisted thorascopic surgery. Computed tomography-guided percutaneous, bronchoscopic and open lung biopsies have been performed with a diagnostic yield of 80-100, 51 and 70%, respectively. Bronchoscopy with bronchoalveolar lavage is generally helpful in diagnosing invasive pulmonary aspergillosis, especially in immunocompromised patients with diffuse lung involvement. The sensitivity and specificity of a positive result of bronchoalveolar lavage fluid are ∼50 and 97%, respectively. All specimens obtained via invasive interventions including bronchoalveolar lavage should be processed for microscopy and cytology, fungal cultures and by means of any other available procedure (e.g., Aspergillus PCR and galactomannan). Combining microscopy and culture will increase the diagnostic yield by 15-20%. Combining culture, microscopy, serology, and Aspergillus PCR in lung tissues and/or bronchial samples will increase the diagnostic yield by 99%.

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“…Their study included patients at low risk for invasive aspergillosis, who frequently received piperacillin-tazobactam (17%) or mold active antifungal therapy (36%), factors known to reduce assay accuracy. Most others report that antigenemia precedes diagnosis and initiation of antifungal therapy [15,16]. Maertens et al [7•] reported detection of antigenemia about 1 week before radiographic or CT findings or positive culture, and also before therapy initiation.…”

Section: Monitoring During Immunosuppressionmentioning

confidence: 99%

Nonculture diagnostic methods for invasive fungal infections

Wheat¹

2007

Curr Infect Dis Rep

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Nonculture methods are useful when diagnosing several systemic or invasive mycoses. Commercially available methods include immunoassays to detect cell wall or capsular polysaccharides; zymogen-based colorimetric assays to detect (13)-beta-D-glucan, another cell wall polysaccharide; and molecular methods to detect fungal DNA. Molecular diagnostic methods have received much attention in the last decade but their accuracy has not been established, in part because of a lack of standardized, commercially available reagents or test kits. Serologic tests for antibodies are useful for diagnosis of histoplasmosis and coccidioidomycosis.

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Usefulness of Sequential Aspergillus galactomannan Antigen Detection Combined With Early Radiologic Evaluation for Diagnosis of Invasive Pulmonary Aspergillosis in Patients Undergoing Allogeneic Stem Cell Transplantation

Cited by 54 publications

References 12 publications

Pulmonary aspergillosis: a clinical review

Pulmonary aspergillosis: a clinical review

Diagnosing Aspergillosis: The Role of Invasive Diagnostic Interventions

Nonculture diagnostic methods for invasive fungal infections

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