The diagnosis of invasive aspergillosis: is early early enough?

R.J.Manuel, S.Ainscough, H.G.Prentice, L.A.Berger, T.Yeghen, M.N.Potter, C.C.Kibbler


Invasive aspergillosis (IA) remains a life-threatening infection in immunocompromised patients and is the most important cause of fungal death in cancer patients; in bone marrow transplant recipients the mortality rate is still greater than 90%. The purpose of this study was to investigate methods for the early diagnosis of IA in patients with haematological malignancy, and to examine the best strategy for sampling. The study compared clinical, microbiological and histopathological data with newer diagnostic techniques such as antigen detection (Pastorex latex agglutination and sandwich ELISA tests), high resolution computed tomography (CT) scanning and the polymerase chain reaction (PCR) (Einsele et al. 1997). The research involved both a retrospective and a prospective study. The initial retrospective study was performed over 24 months. During this time, 38 bronchoalveolar lavage (BAL) fluid and 178 serum samples were collected from 38 febrile neutropenic and bone marrow transplant (BMT) patients. BAL and serum samples from 12 immunocompetent and 20 asymptomatic HIV+ patients were used as controls. The results suggest the sandwich ELISA provides a simple, effective and rapid screening test, and that the higher negative predictive value of PCR may allow for better use of empirical antifungal therapy. Regular prospective monitoring of sequential serum samples with BAL and CT scanning in high risk immunocompromised patients allows for the earlier diagnosis of IA. Based on the above results, a one-year prospective study was performed. However, the prospective study showed that effective prophylaxis with itraconazole is superior to pre-emptive therapy, even at an early stage of infection.

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Full conference title: 

11th European Congress of Clinical Microbiology and Infectious Diseases
    • ECCMID 11th (2001)