Combined galactomannan (GMn), mannan (Mn), and antimannan (AMn) for diagnosis of invasive fungal infections (IFI) in neutropenic cancer patients (Pts)

L. Senn,1 J. O. Robinson,1 S. Schmidt,2 M. Knaup,1 B. Duvoisin,2 J. Bille,1 T. Calandra1 and O. Marchetti1

Author address: 

1CHUV, Infectious Diseases, Lausanne, Switzerland and 2CHUV, Radiodiagnostic, Lausanne, Switzerland

Abstract: 

Background: Invasive aspergillosis (IA) and candidiasis (IC) are lifethreatening complications in neutropenic cancer Pts. Diagnosis remains difficult and is often delayed when relying on conventional methods. Detection of fungal antigens and antibodies may speed up diagnosis and facilitate antifungal Rx. Aim: To evaluate the utility of a combined use of GMn, Mn and AMn. Methods: Prospective evaluation of 125 consecutive episodes of neutropenia (median duration 23 d) in Pts with acute leukemia. IFI was diagnosed according to EORTC-MSG criteria. Blood was collected 2x weekly before onset of fever and daily thereafter. GMn, Mn and AMn were measured by ELISA (Platelia, Bio-Rad). Positive tests defined by two consecutive values of GMn > 0.4 or >0.5 OD Index, of Mn > 0.5 ng mL-1 and of Amn > 10 AU mL-1. Results: 11 IA (three proven, eight probable) and 13 IC (one proven, 12 probable) occurred in 125 neutropenic episodes. 16 samples per episode (335) were analyzed over 35 d (17122).TABLEGMn: sensitivity of 0.4 cut-off was higher than that of 0.5, specificity was similar. Mn/AMn: in 90% of Pts with IC, positive tests preceded clinical diagnosis by a median of 10 d. GMn/Mn/AMn: in 89% of Pts with IFI positivity anticipated conventional diagnosis by a median of 6 d. Conclusions: In neutropenic cancer patients, twice weekly monitoring of GMn/Mn/AMn may facilitate early non-invasive diagnosis of invasive fungal infections.
2005

abstract No: 

O3.6

Full conference title: 

2nd Trends in Medical Mycology
    • TIMM 2nd (2010)