Utilidad de la deteccià³n de antàgeno de Aspergillus en el rastreo y diagnà³stico de aspergilosis nosocomial [in Spanish]
VÃ¡zquez-Tsuji Ã“, GutiÉrrez CastrellÃ³n P, Campos Rivera T, Rojas Garrido A, MartÃnez-Barbabosa I, GarcÃa Camacho G
Date: 27 May 2009
Objective: To determine the usefulness of the galactomannan antigen detection with monoclonal antibodies, direct examination and culture in the monitoring and diagnosis of nosocomial aspergillosis.Material and methods: The population studied was hospitalized children in the Instituto Nacional de Pediatria during an outbreak of nosocomial aspergillosis from October 1st, 1997 to July 31, 1998. Children, were one day to 18 years of age; both genders, with diagnosis of aspergillosis. They were divided in two groups: Group A with nosocomial aspergillosis diagnosed by laboratory tests (antigen detection, direct exam and culture) and radiodiagnosis; Group B with clinical features compatible with aspergillosis which was discharged by laboratory tests (antigen detection, direct exam and culture) and radiodiagnosis. Calculation of the sample was made according to Patterson study with a p1: 60, p2:15, pondered P of 0.365 and a pondered Q of 0.625. Sixty negative patients and 16 positive patients were included.Results: Association between fungus and clinical features were: A. flavus was present in 57.1% of pulmonary cases, A. fumigatus, A. flavus and A. niger were found in 33.3% of the sinusal aspergillosis. In the systemic and mixed forms there was no complete identification. To take on the antigen detection as a gold standard; direct examination had a sensitivity of 0.31 and a specificity of 1.0, positivity predictive value was 1.0, negative predictive value was 0.87. Culture had a sensitivity of 0.54 and a specificity of 0.97, positive predictive value was 0.78, negative predictive value was 0.91.Conclusion: Detection of galactomannan antigen with monoclonal antibodies and direct examination are the most useful tests for the diagnosis of nosocomial aspergillosis. The culture identifies the type of fungus. Based on the results of this study, other 22 cases of nosocomial aspergillosis were detected. In the present paper the mortality was 37.5% compared with 50 to 94% in other series.
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