Earlier Diagnosis of Fusariosis with Aspergillus Serum Galactomannan Testing

Ref ID: 18694

Author:

A. Varon, MD – Clinician, M. L. S. Chiganer, MD – Clinician, M. Garnica, MD – Clinician, H. Reis, MS – Lab Technician, M. Paixao, MS – Lab Technician, G. Barreiros, MS – Lab Technician, T. Akiti, MS – Lab Technician, S. A. Nouer, MD – Associate Profe

Author address:

Federal Univ. of Rio de Janeiro, Rio de Janeiro, Brazil.

Full conference title:

52nd Annual ICAAC

Date: 9 September 2014

Abstract:

Background: Cross-reactivity of Fusarium species with serum galactomannan antigen test (GMI) has been observed. We sought to evaluate if GMI could help to early diagnose invasive fusariosis and to monitor treatment response.
Methods: Serial GMI testing (≥ 3x/week) has been applied to high-risk hematological patients (pts) since 2008. We reviewed the records and GMI results of all pts with a diagnosis of invasive fusariosis between 2008 and 2011. We looked at two time points related to the positive GMI (≥ 0.5 optical density): date of first clinical manifestation of fusariosis (skin lesions, lung infiltrates or swollen joint) and date of diagnosis (date of positive culture, direct exam or histopathology).
Results: Eleven pts were diagnosed with invasive fusariosis. The median number of GMI tests performed was 6 (range 2 – 17). Two pts had negative GMI: one had only one test performed, 3 days before the first manifestation of fusariosis, and the other had localized fusariosis (arthritis) with multiple negative GMI tests. Nine pts (82%) had at least one positive GMI (median 2, range 1 – 15). The median value of the first positive and peak GMI was 0.640 (range 0.506 – 0.910) and 0.910 (range 0.506 – 6.382), respectively. In 5 of these 9 pts GMI was positive before the first manifestation of fusariosis (median 6 days, range 5 – 12), and in 4 clinical manifestations preceded the first positive GMI (9.5 days, range 6 – 14). In 6 pts GMI was positive before the final diagnosis of fusariosis (median 10 days, range 5 – 17), in 1 it was positive on the same day and in 2 the diagnosis preceded positive GMI by 6 and 13 days, respectively. All 9 pts received antifungal therapy (voriconazole 5, posaconazol 1, voriconazole plus amphotericin B 3) and 4 (44%) were cured. Negativation of GMI occurred in 2 of the 4 pts who cured and in 2 of the 5 who died.
Conclusions: GMI is frequently positive in invasive fusariosis, and becomes positive before diagnosis in most pts. These findings may have important implications for the choice of antifungal therapy in settings with high prevalence of fusariosis and positive GMI.

Abstract Number: M-1690

Conference Poster: y

Conference Year: 2012

Link to conference website: NULL

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