Evaluation of invasive aspergillosis in immunsuppresive patients with galactomannan antigen test follow-up

Metin, Dilek Yesim; Pullukçu, Hüsnü; Soylu, Mehmet; Soyer, Nur; Bakir, Ayfer; Isikgöz Tasbakan, Meltem; Saydam, Güray; Hilmioglu-Polat, Süleyha; Inci, Ramazan.

Abstract: 

Aim: Invasive aspergillosis causes a major morbidity and mortality in immunsuppressive patients. Since, clinical findings are not spesific
and conventional diagnostic methods are not sufficient to detect the infection, the importance of new diagnostic approaches is increasing. In
this study, the clinical , laboratory findings and galactomannan antigen test results of immunsuppresive patients attending to Ege University
Hospital were evaluated retrospectively.
Methods: Between May 1, 2013 and May 31, 2014, the immunocompromised patients with GM antigen test follow up results were included in
the study. The demographic characteristics, primary diseases, antifungal therapies, mycological culture results, galactomannan monitoring
results and radiological findings of patients were evaluated for invasive aspergillosis. Accordingly, the patients with positive galactomannan
test results (> 0.5 ng / mL) and with clinical and radiological findings were considered as true-positive while the ones without clinical and
radiological findings were considered as false-positive.
Results: A total of 6994 serum samples of 658 patients with 667 fever attacks were evaluated. Four hundred and eight of the patients were
male and 250 were female. Galactomannan antigen tests were positive in 119 fever attacks of 110 patients. 57 of Galactomannan positive
results (47.8%) were considered as true-positive, while 60 attacks (50.4%) were considered as false-positive. Two attacks couldn’t be
evaluated due to the insufficiency of data (1.6%). 87 attacks were associated with neutropenia (73.1%). Prophylaxic therapies were applied
in 28 attacks. Radiologic findings which supported invasive aspergillosis were determined in 43 attacks (36.1%). Biopsies were applied in 4
patients (2 bronchoscopic biopsies, 2 sinus biopsies) and fungal infections were determined in 3 of 4 patients. 32 of 110 patients (29%) died
during the follow up period.
It was found that 38 of patients with false-positivite results had regular weekly galactomannan test results and in 34 patients a single positive
test result was obtained during the follow-up period. Mycological cultures were applied only 6 of these patients and found as culture positive.
Neutropenic fever attacks were determined in 215 of 548 patients with negative galactomannan test results. 52 of these patients had
undergone antifungal therapy (34 patients with empirical therapy and no fungal infection, 18 patients with fungal infection with different
clinical findings). Nineteen of the non-neutropenic 333 patients had received antifungal therapy (5 patients with empirical therapy and no
substantiated fungal infection, 14 patients with fungal infection ).
Conclusion: Antifungal therapy was initiated and imaging methods were applied earlier in patients with positive galactomannan test results
despite the absence of clinical findings for fungal infection other than fever. Even though positive galactomannan test results are noteworthy
they should be evaluated simultaneously with the clinical and radiological examination findings.

2015

Poster: 

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abstract No: 

EV0957
    • ECCMID 25th (2015)