Sensitivity of Galactomannan Enzyme Immunoassay for diagnosing breakthrough invasive Aspergillosis under Mould-active antifungal prophylaxis/therapy

MARTIN HOENIGL, THOMAS VALENTIN, KATHARINA SEEBER, PHARMD, WALTER BUZ INA, WIEBKE DUETTMANN, JASMIN WAGNER, VOLKER STRENGER and ROBERT KRAUSE

Author address: 

Medical University of Graz, Graz, Austria

Abstract: 

Background: Galactomannan (GM) testing has proven useful for diagnosis and therapy monitoring of invasive Aspergillosis (IA). Data about performance of GM testing in patients with mould active prophylaxis/therapy, however, is limited. Whether sensitivity of GM testing is decreased under mould active antifungal prophylaxis/therapy is therefore still a point of discussion. Methods: We retrospectively analyzed GM test results in patients with underlying hematologic malignancies admitted to the our medical centre beween 2009-2012. Only cases with diagnosis of probable and proven IA being established by other methods than GM testing were included. We compared GM results between patients with mould active therapy/prophylaxis and patients without on weeks -2 and -1. As all patients had received antifungal therapy after diagnosis of IA we further analyzed sensitivity of GM testing under mould active therapy during week 0, 1, and 2. We used a cut off of 0.5 for serum and 1.0 for BAL samples for positivity. Results: A total of 76 GM test results in 9 patients were identified. GM testing was positive in 45 / 76 (59%) of samples. Sensitivity of GM testing for detection of proven or probable IA in patients with and without mould active regimens is displayed in the table. In addition all other 5 cases of probable breakthrough IA occurring under mould active prophylaxis/therapy within the study period were mycologically diagnosed by GM testing only (not included in analysis). Conclusion: We found that GM testing may be a reliable method for diagnosis of breakthrough IA as sensitivity was found 79% at week 0 of IA diagnosis. Also GM sensitivity was not negatively influenced by intake of mould active prophylaxis/therapy at our centre. We therefore propose that GM testing is a useful diagnostic method also in patients receiving mould active prophylaxis/therapy.
2012

abstract No: 

225

Full conference title: 

ID Week 2012
    • IDWeek 2012