Correlation of galactomannan antigen levels with neutrophil counts and iNOS activity in hematogical patients at high risk for invasive aspergillosis

Ref ID: 19413

Author:

S. Keceli, G. Sonmez Tamer, B. Mutlu and A. Aynioglu

Author address:

Kocaeli University, Turkey

Full conference title:

6th Trends in Medical Mycology 2013

Date: 11 October 2014

Abstract:

Objectives The detection of galactomannan (GM) antigen in serum
samples is an important step helping the diagnosis of invasive asper-
gillosis (IA). It is known that polymorphonuclear leucocytes (PMN)
attack hyphae dependinding on the release of reactive oxygen inter-
mediates. We hypothesized that inducible nitric oxide synthase activ-
ity (iNOS) levels or PMN counts can be identified as prognostic
factors of IA besides GM index (GMI). The objective of this study is to
investigate the correlation of PMN counts and iNOS with GMI in
hematological patients with possible IA.
Methods Totally 68 neutropenic patients who were expected to be
neutropenic at least 10 days and acute leukemia and aplastic anemia
patients, were routinely screened twice weekly for GMI. Seventy
seven serum samples that was GMI 0.5 were included in this study.
All the data concerning antibiotics and systemic antifungal treatment
were collected at the time of of serum sampling for the GM assay.
GMI was measured by ELISA (Platelia Aspergillus, Biorad, France).
According to the neutrophil counts, the patients with possible IA
were grouped as group 1 (<100 PMN/mm3), group 2 (100-500 PMN/mm3) and group 3 (>500 PMN/mm3). iNOS levels were mea-
sured by ELISA (Eastbiopharm, China).
Results The demographic features like age, sex, underlying hemato-
logical disorders, treatments, GMI and iNOS levels of patients were
shown (Table). Although the highest GM indices were obtained in
group 1 compared to group 2 and group 3, there was no statistically
significant difference among three groups. In patients with iNOS level
<35 U/L (n = 54), 34 of them had GMI 1 and 35 of them had PMN counts >100 (group 2 and 3). There was no statistical differ-
ence between iNOS levels and PMN counts or GMI. The proportion of
patients receiving antibiotics possibly responsible for false-positive GM
results were not statistically different among groups. However, most
of the patients using especially piperacillin-tazobactam had GMI 1
(p = 0.03). GMI of patients receiving antifungal therapy did not differ
among three groups. Antifungal therapy did not significantly affect
GM results.
Conclusion The GMI is higher in severely neutropenic patients (<100 PMN) than in other (100 PMN) patients. However, high GMI may be false-positive due to antibiotic usage. In patients with 100 PMN counts, iNOS levels would also be expected low. This probably means that iNOS levels are increasing in order to fight with fungal conidia if there is a progression to IA. Therefore, PMN counts correlated with iNOS activity should be kept in mind in routine use of GM assay.

Abstract Number: p172

Conference Year: 2013

Link to conference website: NULL

New link: NULL

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