Korean J Intern Med.  2015 Nov;30(6):899-905. 10.3904/kjim.2015.30.6.899.

Serum galactomannan levels in the diagnosis of invasive aspergillosis

• Okuturlar
• Ozkalemkas F
• Ener B
• Serin SO
• Kazak E
• Ozcelik T
• Ozkocaman
• Ozkan HA
• Akalin H
• Gunaldi M
• Ali R

• KMID: 2381595
• DOI: http://doi.org/10.3904/kjim.2015.30.6.899

Abstract

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 > or = 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.

Keyword

Invasive aspergillosis; Galactomannan test; Cut-off value; Sensitivity and specificity; Enzyme-linked immunosorbent assay

MeSH Terms

Adult
Aged
Antineoplastic Agents/*adverse effects
Biomarkers/blood
Enzyme-Linked Immunosorbent Assay
Female
Hematologic Neoplasms/diagnosis/*therapy
Hematopoietic Stem Cell Transplantation/*adverse effects
Humans
Immunocompromised Host
Immunosuppressive Agents/*adverse effects
Invasive Pulmonary Aspergillosis/*blood/diagnosis/immunology/microbiology
Male
Mannans/*blood
Middle Aged
Opportunistic Infections/*blood/diagnosis/immunology/microbiology
Predictive Value of Tests
Reproducibility of Results
Time Factors
Antineoplastic Agents
Biomarkers
Immunosuppressive Agents
Mannans