Role of bi-weekly serum galactomannan screening for the diagnosis of invasive aspergillosis in haematological cancer patients.
Details
Serval ID
serval:BIB_5633E535BA9A
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Role of bi-weekly serum galactomannan screening for the diagnosis of invasive aspergillosis in haematological cancer patients.
Journal
Mycoses
ISSN
1439-0507 (Electronic)
ISSN-L
0933-7407
Publication state
Published
Issued date
06/2018
Peer-reviewed
Oui
Volume
61
Number
6
Pages
350-354
Language
english
Notes
Publication types: Case Reports ; Journal Article
Publication Status: ppublish
Publication Status: ppublish
Abstract
Invasive aspergillosis (IA) is a life-threatening infection affecting haematological cancer patients with chemotherapy-induced neutropenia. The diagnosis of IA often relies on the detection of galactomannan (GM) in serum or bronchoalveolar lavage fluid (BAL). Bi-weekly serum GM screening has been proposed for a pre-emptive therapeutic approach of IA in patients not receiving mold-active prophylaxis. We have analysed all IA cases among patients with haematological malignancies and prolonged chemotherapy-induced neutropenia (>14 days) in our institution over a 10-year period (2007-2017). Serum GM was measured twice weekly and mold-active prophylaxis was not routinely administered. Thirty IA cases were observed and a positive serum GM was the first indicator of IA in 10 (33%) of them, which represents a need of approximately 500 GM tests for the detection of a single IA case. In the other 20 (67%) cases, suggestive chest CT lesion was the first sign of IA and bronchoscopy was required in 15 (50%) cases with negative serum GM for establishing the diagnosis of probable/proven IA. A positive serum GM was associated with a worse prognosis (57% 12-week survival vs 100% among serum GM-negative patients, P = .006), irrespective of the timing of GM positivity compared to CT. We concluded that bi-weekly serum GM screening demonstrated limited benefit in this population.
Keywords
Adult, Aged, Aspergillus/genetics, Aspergillus/isolation & purification, Bronchoalveolar Lavage Fluid/chemistry, Bronchoalveolar Lavage Fluid/microbiology, Female, Hematologic Neoplasms/complications, Hematologic Neoplasms/microbiology, Humans, Invasive Pulmonary Aspergillosis/diagnosis, Invasive Pulmonary Aspergillosis/epidemiology, Invasive Pulmonary Aspergillosis/microbiology, Male, Mannans/blood, Middle Aged, Neutropenia/complications, Polymerase Chain Reaction, Prognosis, Retrospective Studies, Sensitivity and Specificity, Aspergillus, PCR, acute leukaemia, bronchoscopy, invasive fungal infection
Pubmed
Web of science
Create date
01/03/2018 20:20
Last modification date
20/08/2019 14:10