Utility of galactomannan enzyme immunoassay and (1,3) β-D-glucan in diagnosis of invasive fungal infections: low sensitivity for Aspergillus fumigatus infection in hematologic malignancy patients


Hachem RY, Kontoyiannis DP, Chemaly RF, Jiang Y, Reitzel R, Raad I

Date: 4 December 2008


Previous studies have reported that galactomannan (GM) enzyme immunoassay and 1-3 β-glucan (BG) assay may be useful diagnostic tools, but their sensitivity is variable. We compared the performance of both tests. Between October 2002 and May 2005, 82 patients were prospectively followed for 12 weeks. A total of 414 samples were tested by GM and 409 samples by BG in 4 groups of patients: invasive aspergillosis (IA), other mold (Fusarium, scedosporium, zygomycosis, etc.), candidemia, and control patients. Blood samples were obtained twice on week 1 and once every other week for a total of 12 weeks. Patients in the invasive fungal infection (IFI) groups had comparable risk factors. The sensitivity of the GM test was significantly higher for patients with IA due to non-fumigatus Aspergillus spp. than patients with IA due to A. fumigatus (49% vs 13%, p<0.0001) or other mold infection (49% vs 6%, p<0.0001). However, the sensitivity ranges (47%-64% and specificity (88%) of BG assays were comparable among all patients tested, regardless of the infecting pathogen. The performance of GM-based diagnosis appears better in detecting Aspergillus non-fumigatus species. The diagnostic marker BG was shown to have better sensitivity than GM in detecting IA and other mold infections in hematologic malignancy patients.

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