The Korean journal of internal medicine

  • 제30권6호
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  • Pages.899-905
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  • 2015
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  • 1226-3303(pISSN)
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  • 2005-6648(eISSN)
대한내과학회 (The Korean Association of Internal Medicine)
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Serum galactomannan levels in the diagnosis of invasive aspergillosis

  • Okuturlar, Yildiz (Department of Internal Medicine, Bakirkoy Dr. Sadi Konuk Education and Research Hospital) ;
  • Ozkalemkas, Fahir (Department of Hematology, Uludag University Faculty of Medicine) ;
  • Ener, Beyza (Department of Medical Mycology and Microbiology, Uludag University Faculty of Medicine) ;
  • Serin, Sibel Ocak (Department of Internal Medicine, Umraniye Education and Research Hospital) ;
  • Kazak, Esra (Department of Infectious Diseases and Clinical Microbiology, Uludag University Faculty of Medicine) ;
  • Ozcelik, Tulay (Bone Marrow Transplantation Center, Florence Nightingale Hospital) ;
  • Ozkocaman, Vildan (Department of Hematology, Uludag University Faculty of Medicine) ;
  • Ozkan, Hasan Atilla (Department of Hematology, Yeditepe University Faculty of Medicine) ;
  • Akalin, Halis (Department of Infectious Diseases and Clinical Microbiology, Uludag University Faculty of Medicine) ;
  • Gunaldi, Meral (Department of Oncology, Bakirkoy Dr. Sadi Konuk Education and Research Hospital) ;
  • Ali, Ridvan (Department of Hematology, Uludag University Faculty of Medicine)
  • 투고 : 2015.02.08
  • 심사 : 2015.06.20
  • 발행 : 2015.11.01
⟨ 이전 논문 다음 논문 ⟩

초록

Background/Aims: In this study, the sensitivity-specificity of galactomannan-enzyme immunoassay (GM-EIA) with a cut-off value of 0.5 for a single, two, or three consecutive positivity in the diagnosis of invasive pulmonary aspergillosis (IPA) in neutropenic patients with hematological malignancy was investigated. Methods: IPA was classified as "proven," "probable," or "possible" as described in the guidelines prepared by the European Organization for Research and Treatment of Cancer and Mycoses Study Group." Serum samples were collected from the patients twice a week throughout their hospitalization. A total of 1,385 serum samples, with an average of 8.3 samples per episode, were examined. Results: Based on the 165 febrile episodes in 106 patients, 80 (48.5%) were classified as IPA (4 proven, 11 probable, 65 possible) and 85 (51.5%) as non-IPA. The sensitivity/specificity was 100%/27.1% for a single proven/probable IPA with the cut of value of GM-EIA ${\geq}0.5$, 86.7%/71.8% for two consecutive positive results, and 73.3%/85.9% for three consecutive positive results. Conclusions: With the galactomannan levels measured twice a week, consecutive sensitivity decreased and specificity increased. Therefore, an increase may be obtained in sensitivity-specificity by more frequent monitoring of GM-EIA starting from the first day of positivity is detected.

키워드

참고문헌

  1. Dykewicz CA; Centers for Disease Control and Prevention (U.S.); Infectious Diseases Society of America; American Society of Blood and Marrow Transplantation. Summary of the guidelines for preventing opportunistic infections among hematopoietic stem cell transplant recipients. Clin Infect Dis 2001;33:139-144. https://doi.org/10.1086/321805
  2. Verweij PE, Stynen D, Rijs AJ, de Pauw BE, Hoogkamp- Korstanje JA, Meis JF. Sandwich enzyme-linked immunosorbent assay compared with Pastorex latex agglutination test for diagnosing invasive aspergillosis in immunocompromised patients. J Clin Microbiol 1995;33:1912-1914.
  3. Pagano L, Caira M, Candoni A, et al. The epidemiology of fungal infections in patients with hematologic malignancies: the SEIFEM-2004 study. Haematologica 2006;91:1068-1075.
  4. Ozcelik T, Ozkalemkas F, Kocaeli H, et al. Successful treatment of neuroaspergillosis in a patient with acute lymphoblastic leukemia: role of surgery, systemic antifungal therapy and intracavitary therapy. Mikrobiyol Bul 2009;43:499-506.
  5. Lehrnbecher T, Frank C, Engels K, Kriener S, Groll AH, Schwabe D. Trends in the postmortem epidemiology of invasive fungal infections at a university hospital. J Infect 2010;61:259-265. https://doi.org/10.1016/j.jinf.2010.06.018
  6. Arikan S. Clinical microbiology and infectious diseases. Management of fungal infections. IDrugs 2001;4:746-749.
  7. Mennink-Kersten MA, Donnelly JP, Verweij PE. Detection of circulating galactomannan for the diagnosis and management of invasive aspergillosis. Lancet Infect Dis 2004;4:349-357. https://doi.org/10.1016/S1473-3099(04)01045-X
  8. Stynen D, Sarfati J, Goris A, et al. Rat monoclonal antibodies against Aspergillus galactomannan. Infect Immun 1992;60:2237-2245.
  9. Stynen D, Goris A, Sarfati J, Latge JP. A new sensitive sandwich enzyme-linked immunosorbent assay to detect galactofuran in patients with invasive aspergillosis. J Clin Microbiol 1995;33:497-500.
  10. Yucesoy M, Ergon MC. Investigation of Aspergillus galactomannan levels in antimicrobial agents. Mikrobiyol Bul 2007;41:565-570.
  11. Agca H, Ener B, Yilmaz E, et al. Comparative evaluation of galactomannan optical density indices and culture results in bronchoscopic specimens obtained from neutropenic and non-neutropenic patients. Mycoses 2014;57:169-175. https://doi.org/10.1111/myc.12126
  12. De Pauw B, Walsh TJ, Donnelly JP, et al. Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group. Clin Infect Dis 2008;46:1813-1821. https://doi.org/10.1086/588660
  13. Maertens J, Buve K, Theunissen K, et al. Galactomannan serves as a surrogate endpoint for outcome of pulmonary invasive aspergillosis in neutropenic hematology patients. Cancer 2009;115:355-362. https://doi.org/10.1002/cncr.24022
  14. Marr KA. Aspergillus galactomannan index: a surrogate end point to assess outcome of therapy? Clin Infect Dis 2008;46:1423-1425. https://doi.org/10.1086/528715
  15. Miceli MH, Grazziutti ML, Woods G, et al. Strong correlation between serum aspergillus galactomannan index and outcome of aspergillosis in patients with hematological cancer: clinical and research implications. Clin Infect Dis 2008;46:1412-1422. https://doi.org/10.1086/528714
  16. Pfeiffer CD, Fine JP, Safdar N. Diagnosis of invasive aspergillosis using a galactomannan assay: a meta-analysis. Clin Infect Dis 2006;42:1417-1427. https://doi.org/10.1086/503427
  17. Ilstrup DM. Statistical methods in microbiology. Clin Microbiol Rev 1990;3:219-226. https://doi.org/10.1128/CMR.3.3.219
  18. Machetti M, Feasi M, Mordini N, et al. Comparison of an enzyme immunoassay and a latex agglutination system for the diagnosis of invasive aspergillosis in bone marrow transplant recipients. Bone Marrow Transplant 1998;21:917-921. https://doi.org/10.1038/sj.bmt.1701206
  19. Maertens J, Verhaegen J, Demuynck H, et al. Autopsy-controlled prospective evaluation of serial screening for circulating galactomannan by a sandwich enzyme-linked immunosorbent assay for hematological patients at risk for invasive Aspergillosis. J Clin Microbiol 1999;37:3223-3228.
  20. Maertens J, Verhaegen J, Lagrou K, Van Eldere J, Boogaerts M. Screening for circulating galactomannan as a noninvasive diagnostic tool for invasive aspergillosis in prolonged neutropenic patients and stem cell transplantation recipients: a prospective validation. Blood 2001;97:1604-1610. https://doi.org/10.1182/blood.V97.6.1604
  21. Maertens J, Van Eldere J, Verhaegen J, Verbeken E, Verschakelen J, Boogaerts M. Use of circulating galactomannan screening for early diagnosis of invasive aspergillosis in allogeneic stem cell transplant recipients. J Infect Dis 2002;186:1297-1306. https://doi.org/10.1086/343804
  22. Tanriover MD, Ascioglu S, Altun B, Uzun O. Galactomannan on the stage: prospective evaluation of the applicability in routine practice and surveillance. Mycoses 2010;53:16-25.
  23. Rohrlich P, Sarfati J, Mariani P, et al. Prospective sandwich enzyme-linked immunosorbent assay for serum galactomannan: early predictive value and clinical use in invasive aspergillosis. Pediatr Infect Dis J 1996;15:232-237. https://doi.org/10.1097/00006454-199603000-00011
  24. Marr KA, Carter RA, Boeckh M, Martin P, Corey L. Invasive aspergillosis in allogeneic stem cell transplant recipients: changes in epidemiology and risk factors. Blood 2002;100:4358-4366. https://doi.org/10.1182/blood-2002-05-1496

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  2. Treating invasive aspergillosis in patients with hematologic malignancy: diagnostic-driven approach versus empiric therapies vol.18, pp.None, 2015, https://doi.org/10.1186/s12879-018-3584-9
  3. A novel diagnosis scoring model to predict invasive pulmonary aspergillosis in the intensive care unit vol.40, pp.2, 2015, https://doi.org/10.15537/smj.2019.2.22940
  4. Epidemiology and treatment approaches in management of invasive fungal infections in hematological malignancies: Results from a single-centre study vol.14, pp.5, 2015, https://doi.org/10.1371/journal.pone.0216715