We have analyzed serial serum and urine specimens for Aspergillus galactomannan antigen (PlateliaR, Sanofi-Pasteur, France) from 100 hematological patients receiving empirical amphotericin-B therapy for suspected fungal infection. A total of 375 serum and 304 urine specimens were tested. Aspergillus antigen was detected in 20 patients (serum positive in 16 patients, urine positive in 10 patients). Eleven patients had two or more consecutive positive samples. Aspergillus antigen was detected simultaneously in serum and urine specimens in 7 patients. The rate of positivity for serum and urine specimens were 52/375 (14%) and 15/304 (5%), respectively. A 10-fold concentration of urine specimens increased the rate of positive urine samples to 29/304 (10%). BAL specimens from 12 neutropenic patients with pulmonary infiltrates were tested and 5/12 (42%) of these were positive for aspergillus antigen. The clinical material included 4 patients with autopsy confirmed invasive aspergillosis, and aspergillus antigen was detected in all four of them (serum positive in 4 patients, concentrated urine positive in 2 patients and BAL positive in 2 patients). All serum (10/10) and concentrated urine specimens (9/9) taken after the first positive antigen detection remained positive in these patients. Four patients with other invasive fungal infections (3 candidemias and 1 mucormycosis) were all negative for aspergillus antigen. In 4 patients with a successful outcome, the repeatedly positive aspergillus antigen tests turned negative during the empirical amphotericin-B treatment. We conclude, that in addition to serum specimens, aspergillus galactomannan antigen can be detected also in urine and BAL specimens of patients receiving empirical amphotericin-B therapy. The low sensitivity of urine antigen detection can be considerably improved by a ten-fold concentration of the specimen. Disappearance of galactomannan antigen from the samples of patients responding to antifungal therapy seems to correlate with a good clinical outcome.
Full conference title:
38th Interscience Conference on Antimicrobial Agents and Chemotherapy
- ICAAC 38th