Detection of Early Stage Pulmonary aspergillosis by Combined ELISA Assay and Chest CT Scan.

Nicola Mordini, Daniele Mattei, Cristiana Lo Nigro, Andrea Gallamini, Donatella Ghirardo, Roberto Priotto, Maria Teresa Ferrua, Claudio Viscoli (Intr. by Francesco Frassoni)

Author address: 

Hematology Department, S.Croce Hospital, Cuneo, Cuneo, Italy; Radiology Department, S.Croce Hospital, Cuneo, Cuneo, Italy; Laboratory Department, S.Croce Hospital, Cuneo, Cuneo, Italy; Compromised Host Unit, National Cancer Institute, Genoa, Genoa,

Abstract: 

Introduction: the diagnosis of invasive aspergillosis ( IA) in neutropenic patients affected by hematological neoplasms is cumbersome, due to the difficulty of obtaining adeguate bioptic and cultural specimens, very scarce results of radiological detection of early lesions, inadeguate results of serological tests. RT-PCR detection of DNA is still under study, and detection of galactomannan by ELISA is sensible, but not particulary specific. Patients and methods: we performed 780 seriated ELISA assays twice a week in 68 auto/allo and neutropenic patients at risk for invasive mycoses ( neutropenia , GVHD, high-dose chemotherapy, immunosupressive treatment) : 7 alloBMT (4 ANLL, 1 MM,1 BC CML, 1 HD), 32 autoBMT (11 MM, 16 NHL, 1 HD, 3 CLL, 1 ANLL), 1 MM, 16 ANLL, 1 CLL, 1 HCL, 5 NHL, 2 ALL, 3 SAA. Antifungal prophylaxis included fluconazole, itraconazole or low-dose amphotericin B (Am-B). The results of ELISA assay were considered positive in a single patient, if at least two consecutive positive tests were obtained . All febrile patients and/or with ELISA positivity entered a program of radiological survey by weekly chest CT scan. Results : 731 assays out of 780 were negative. There were 31 positive results for 12 affected (positive) patientes, developing IA as follows: 3 proven cases, and 9 probable according the revised EORTC Mycoses Study Group criteria; in all the patients positivity of ELISA assay was sustained and durable , and decreased with the efficacy of antifungal treatment. At the onset of ELISA assay positivity the chest RX was often negative; while the chest CT scan detected initially subtle pulmonary changes, suggestive of fungal lesions, and thereafter became diagnostic of IA. The remaining 56 patients (including 10 with a single positive test and 4 with two non consecutive positive assays) never developed IA. Sensitivity and specificity of ELISA assay (considering proven and probable IA diagnoses) were 100%. At onset of ELISA assay positivity the patients were given 1-1,5 mg/kg/day Amb-B, eventually changed to 3-5 mg/kg/day liposomal Am-B. In 3 ANLL, 1 HD and 1 ALL patients, refractory to liposomal am-B, voriconazole determined improvement of pulmonary cavitations , enabling one patient to undergo to alloBMT and one to autograft. Mortality was high in allo BMT (42%) and lower in auto BMT (12,5%) . Conclusion : we suggested that combination of routinary, twice a week, ELISA assay and weekly chest CT scan could enable an early diagnosis of pulmonary IA, for targeted antifungal treatment
2001

abstract No: 

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Full conference title: 

43rd American Society of Hematology (ASH) Annual Meeting
    • ASH 43rd (2001)