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Detection of Serum Galactomannan in Early Diagnosis of Invasive Aspergillosis in Patients with Hematological Malignancies and Stem Cell Transplantation

Author: XuJie
Tutor: SunZiMin
School: Anhui Medical University,
Course: Internal Medicine
Keywords: galactomannan (GM) invasive aspergillosis(IA) invasive fungal infection(IFI)
CLC: R733
Type: Master's thesis
Year: 2011
Downloads: 35
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Abstract

Objective: Invasive fungal infection(IFI) caused by aspergillus is common severe opportunistic infection of patients with hematologic disease/cancer or stem cell transplantation,which is difficult to diagnose early and has a higher mortality.This study is to evaluate the sensitivity and specificity of GM detection for early diagnosis of invasive fungal disease, the cut-off of GM, diagnosis-level changing after GM test, GM value corresponding with the therapy effect.Methods: 308 serum samples of 60 inpatients with high IA risk of hematology department from July 2007 to December 2009 in Anhui provincal hospital were selected according to the domestic standard of“Experimental study of antigen in the early diagnosis of hematological malignancies and stem cell transplantation in patients with invasive fungal infection”.The serum GM concentration was detected by platelia Aspergillus double-sandwich enzyme linked immunosorbent assay (ELISA) .The data of clinical、pathological、laboratory manifestation、images and therapeautic effect were also collected.According to the diagnostic criteria of invasive fungal infections in China,the changes of diagnosis and GM concentration before and after antifungal treatment were evaluated and statistical analysis of the evaluation indexes were performed.Results: The sensitivity、specificity、Positive Predictive values and negative Predictive values of the ELISA were 87.50%、82.90%、77.80%、87.90% respectively by using the serum GM cut-off value of single index>0.8and/or two consecutive index>0.5.Comparing with the given reagent serum GM cut-off index>1.5,it had a increased sensitivity,without obvious decreased specificity,The number of the clinical diagnosis of IA were rose from one case to 24 cases , 12 non-infective patients rose to possible IA with the help of GM detection, GM test was positive 5.2±4.3(3-11d)d ahead of CT scan,ahead of sputum culture 6d(only one positive patient was found),A fluctuant reduction of GM level was found in patients sensitive to antifungal treatment,and an increased or constant GM level in insensitive patients.Conclusions: Comparing with other diagnostic accessory examination such as Clinical performance、typical CT imaging and direct microbiological test ,Serum GM antigen detection had an obvious advantage on the positive rate and time;Comparing with other index,single index>0.8 and/or two consecutive index>0.5 could inerease the sensitivity without obvious decreased specificity. GM test positive as a starting Point to Pre-empt the anti-Aspergillus treatment can reduce mortality of IA Patients. We can estimate the anti-fungal effect by dynamic detection of serum galactomannan. GM is an effective method for early Diagnosis of IA.

Detection of Serum Galactomannan in Early Diagnosis of Invasive Aspergillosis in Patients with Hematological Malignancies and Stem Cell Transplantation

Abstract

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