Purpose: This diagnostic validity trial aims to establish the efficacy of the determination of galactomannan in serum of oncohematologic pediatric patients with suspected pulmonary aspergillosis, comparing it with chest tomography (CT) findings and lung biopsy. Methods: This investigation has two phase. In Phase 1 we retrospectively analyzed the clinical charts of oncohematologic patients with suspected aspergillosis studied with chest CT and galactomannan between January 1 and December 31 2006. They were classified according to the EORTC/MSG criteria. This work allowed us to design a diagnostic algorithm that was used in a second prospective phase between January 1, 2007 and July 31, 2008, used to calculate statistical indicators for galactomannan in pediatric oncohematology patients. Results: In Phase 1, 7 patients between 0 and 18 years old were included, finding 1 proven, 3 probable and 3 possible cases of invasive aspergillosis. For galactomannan sensibility was 50%, specificity was 100%, positive predictive value (PPV) was 100% and negative predictive value (NPV) was 60%. Using the diagnostic algorithm designed with Phase 1 results, we excuted Phase 2. 36 cases were analyzed, finding 19 possible, 9 probable, 4 proven cases and 4 negative cases. Sensitivity was 92%, specificity was 100%, PPV was 100% and NPV was 66%. Conclusions: This findings show that in pediatric oncohematologic patients galactomannan is useful for the diagnosis of invasive aspergillosis, specially if it is performed in patients using immunosupressive therapy, with prolonged and severe neutropenia, fever, cough and chest CT with halo signs. Using the algorithm along with galactomannan determination allows an early and risk free diagnosis to start treatment and improve survival in this group.
Full conference title:
4th Advances Against Aspergillosis
- AAA 4th (2010)