Objectives: Invasive Fungal Infections (IFI) constitutes a substantial source of morbidity and mortality among immunocompromised patients. Morbidity and mortality among patients following HSCT is high. Rapid diagnosis and early treatment of IFI are crucial, yet, limited by other complications of HSCT and the need for invasive procedures mainly to identify IPA. Our study was designed to investigate the impact of serial Serum Galactomannan Assay (GMA) on the diagnosis of IPA. Methods: Children with high risk leukemia or following HSCT were included. Serum samples for GMA (Platela, Aspergillus EIA, Biorad, France) were taken twice weekly from patients at high risk for IFI over 10 months (February-November 2010). Results over 0.5 were considered positive. Patients suspected to have IA were stratifi ed as possible, probable and defi nite according to recent consensus (Clinical Infectious Diseases 2008; 46:1813-21). Results: 27 patients were included. Median age was 11( range 1-21 years). 306 samples were processed. Of 22 HSCT children 15 were after allogeneic and 7 patients after autologous bone marrow transplantation. 5 patients had high risk leukemia. 20 patients had prolonged period of screening from 1 to 7 months. In 7 children only 1-3 samples were obtained. GMA was negative in 14 patients; none was suspected to have IA. 13 patients had 1-4 positive GMA. Four of these 13 children (30%) had criteria of possible IPA and due to positive GMA results were upgraded to the category of probable IPA and started early antifungal treatment. However in 9/13 (70 %) of patients the test was considered false positive without any sign of IA. In our group, 6 of 13 patients (60%) showed positive Galactomannan index during high dose chemotherapy or irradiation as well as during infusion of stem cells; another 40% had positive index during Piperacillin-tazobactam treatment, engraftment period and other viral infection (EBV and HHV-6). Conclusion: GMA may have an important role in the follow up for high risk patients and support early evaluation and treatment for IA. Negative predictive value is high among children. False positive rate is high. The cost benefi t of early detection versus. over diagnosis and performing more specifi c tests in children should be further evaluated.
Full conference title:
Annual Meeting of the EBMT, 37th
- EBMT 37th (2011)