scholarly journals Using Serum Galactomannan Levels to Guide Early Anti-fungal Therapy in Haematology Patients at Risk of Invasive Aspergillosis

2008 ◽  
Vol 12 ◽  
pp. S37
Author(s):  
Ban Hock Tan ◽  
Nidhi Chlebicka ◽  
Jenny Guek Hong Low ◽  
Gee Chuan Wong
Keyword(s):  
At Risk ◽  
Invasive Aspergillosis ◽  
Patients At Risk ◽  
Haematology Patients ◽  
Anti Fungal

scholarly journals Aspergillus fumigatus Antigen Detection in Sera from Patients at Risk for Invasive Aspergillosis

2000 ◽  
Vol 38 (1) ◽  
pp. 438-443
Author(s):  
Bernabé F. F. Chumpitazi ◽  
Claudine Pinel ◽  
Bernadette Lebeau ◽  
Pierre Ambroise-Thomas ◽  
Renee Grillot
Keyword(s):  
At Risk ◽  
Invasive Aspergillosis ◽  
Aspergillus Fumigatus ◽  
Polyclonal Antibodies ◽  
Latex Agglutination ◽  
Control Group ◽  
Molecular Weights ◽  
Circulating Antigens ◽  
Patients At Risk ◽  
Sensitivity Specificity

ABSTRACT We have developed an inhibition enzyme immunoassay (inhibition-EIA) to monitor for the occurrence of invasive aspergillosis (IA) in sera from 45 immunocompromised (IC) patients. The test uses rabbit polyclonal antibodies and a mixture of components from Aspergillus fumigatus , containing three predominant antigens with molecular weights of 18,000, 33,000, and 56,000. Circulating antigens were found in five of seven proven cases of IA due to A. fumigatus . In two of the five positive cases, antigenemia was detected with inhibition-EIA earlier than with X ray or other biological methods. No antigens were detected in the sera from two patients with proven IA due to Aspergillus flavus and Aspergillus terreus nor in the sera from four patients with probable IA. Circulating antigens were not detected in the control group, composed of 30 healthy adult blood donors. Four of the 32 at-risk patients examined, though they displayed no definite evidence of IA, gave a positive result in this test. The sensitivity, specificity, and positive predictive value of inhibition-EIA were 71.4, 94.4, and 71.2%, respectively. The data were compared with those obtained by a latex agglutination assay of galactomannan (GM) that was positive in only one patient with probable IA. The higher sensitivity obtained by inhibition-EIA may well be due to its ability to detect circulating antigens other than GM in the sera of IC patients with IA. Detecting these antigens may improve the diagnosis of IA, as they may serve as markers of this infection.

Validation of Serum Aspergillus Galactomannan Index as a Surrogate Endpoint for Outcome of Invasive Aspergillosis: Clinical and Research Implications.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 2861-2861 ◽  
Author(s):  
Gail Woods ◽  
Marisa Miceli ◽  
Monica Grazziutti ◽  
Somashekar Krishna ◽  
Nayyar Syed ◽  
...  
Keyword(s):  
At Risk ◽  
Clinical Outcome ◽  
Invasive Aspergillosis ◽  
Composite Endpoint ◽  
Surrogate Endpoint ◽  
Laboratory Findings ◽  
Hematological Cancer ◽  
Non Invasive ◽  
Patients At Risk ◽  
Neutropenic Patients

Abstract Background: Assessing clinical outcome of aspergillosis with conventional clinical and laboratory criteria is difficult. A composite “global outcome response” (clinical, radiologic, pathologic and microbiologic criteria) is frequently used but suffers from poor sensitivity and specificity, and has not been standardized or validated. A reliable, quantitative, non-invasive, and easy to measure laboratory test than can substitute for this composite endpoint, i.e. serve as a surrogate endpoint for aspergillosis outcome is highly desirable. Galactomannan (GM) is an Aspergillus-specific polysaccharide released during aspergillosis and detected by the serum GM test. The test which is reported as an index of optical density (OD) is an accepted diagnostic marker for aspergillosis and preliminary data suggest a correlation between GM index (GMI) and outcome. Purpose: To evaluate serum GMI as a surrogate endpoint for outcome of invasive aspergillosis in patients with hematological cancer. Patients and Methods: patients at risk for aspergillosis (11/03-2/06) underwent GMI screening during periods at risk. The clinical and laboratory findings of patients with ≥ 2 (+) GMI (OD ≥ 0.5) were reviewed. To validate GMI as a surrogate endpoint for aspergillosis, a k correlation concordance coefficient test between GMI and an objective clinical outcome of aspergillosis (death) was applied. The correlation is considered perfect when k is 1.0; excellent when ≥ 0.75. Results: 30 patients had GMI (+) aspergillosis of the respiratory tract [myeloma 92%; median age: 59 years (27–75); 15 males]. Aspergillosis developed following stem cell transplantation [autologous (11), allogeneic (1)], or after conventional chemotherapy (18). Among 25 neutropenic patients (<1000/ml), persistent GMI elevation was associated with death (5/5 patients) while return to negative values predicted survival (20/20 patients). Among 5 non-neutropenic patients, 1 with persistently elevated GMI died compared to no death among the remaining 4 whose GMI became negative. Overall, the GMI correlated with clinical outcome in all 30 patients with a perfect 1.0 k correlation concordance coefficient. Conclusion: we have validated GMI as an excellent surrogate endpoint for the outcome of invasive aspergillosis among patients with hematological cancer. This FDA-approved test is reproducible, quantitative, non-invasive, easy to measure and widely available. These findings have important implications for patient care and for the design of clinical trials of mould-active antifungal agents.

scholarly journals Invasive Aspergillosis as an Under-recognized Superinfection in COVID-19

2020 ◽  
Vol 7 (7) ◽  
Author(s):  
George R Thompson III ◽  
Oliver A Cornely ◽  
Peter G Pappas ◽  
Thomas F Patterson ◽  
Martin Hoenigl ◽  
...  
Keyword(s):  
At Risk ◽  
Invasive Aspergillosis ◽  
Viral Infections ◽  
Pulmonary Aspergillosis ◽  
Large Numbers ◽  
Patients At Risk ◽  
Respiratory Viral Infections

Pulmonary aspergillosis has been increasingly reported following severe respiratory viral infections. Millions have been infected by SARS-CoV-2, placing large numbers of patients at-risk for COVID-19 associated pulmonary aspergillosis (CAPA). Prompt recognition of this syndrome and is paramount to improve outcomes.

scholarly journals Detection of galactomannan in bronchoalveolar lavage of the intensive care unit patients at risk for invasive aspergillosis

2015 ◽  
Vol 1 (1) ◽  
pp. 12-17 ◽  
Author(s):  
Sadegh Khodavaysi ◽  
Mohmmad Taghi Hedayati ◽  
Masoud Alialy ◽  
Mohammad Reza Habibi ◽  
Hamid Badali ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
At Risk ◽  
Intensive Care ◽  
Bronchoalveolar Lavage ◽  
Invasive Aspergillosis ◽  
Patients At Risk

Immune Reconstruction Inflammatory Syndrome (IRIS) with Invasive Aspergillosis (IA) in Patients (pts) with Hematological Cancer (Hem-Ca): Clinical and Research Implications.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 5313-5313
Author(s):  
Marisa Miceli ◽  
Monica Grazziutti ◽  
Gail Woods ◽  
Somashekar Krishna ◽  
Elias Kiwan ◽  
...  
Keyword(s):  
At Risk ◽  
Invasive Aspergillosis ◽  
Diagnostic Procedures ◽  
Laboratory Findings ◽  
Neutrophil Recovery ◽  
Specific Polysaccharide ◽  
Patients At Risk ◽  
Investigational Agents ◽  
Therapy Modification ◽  
Inflammatory Syndrome

Abstract Background: Assessing IA outcome with conventional criteria is difficult particularly when clinical and radiological worsening coincides with neutrophil recovery. This worsening is assumed to be related to immune reconstitution (IRIS). Because it is not possible to distinguish between pts whose worsening is transient from those who have progressive IA, clinical and radiological deterioration usually prompts invasive diagnostic procedures and therapeutic modifications including investigational agents, surgery, others. Galactomannan (GM) is an Aspergillus-specific polysaccharide released during aspergillosis and detected by the serum GM test. This FDA-approved test is an accepted diagnostic marker for aspergillosis and preliminary data suggest a correlation between GM index (GMI) and outcome. Purpose: using GMI, to distinguish response from progressive IA among patients with IRIS. Patients and Methods: patients at risk for IA (11/03–2/06) underwent GMI screening during periods at risk. The clinical and laboratory findings of pts with ≥ 2 (+) GMI (optical density ≥ 0.5) were reviewed. Results: 30 pts had GMI (+) aspergillosis of the respiratory tract [myeloma 92%; median age: 59 years (27–75); 15 males]. Invasive aspergillosis developed following stem cell transplantation [autologous (11), allogeneic (1)], or conventional chemotherapy (18). 12 of 25 (48%) neutropenic pts (<1000/ml) developed transient clinical and radiological worsening coinciding with neutrophil recovery, suggesting an IRIS. This deterioration coincided with rapidly declining GMI in 7 pts, all of whom survived with complete resolution of IA and without therapeutic modifications while the remaining 5 pts had persistently elevated GMI and rapidly died of IA. Conclusion: These data establish the presence of IRIS among Hem-Ca pts with IA who suffer clinical and radiologic deterioration coinciding with neutrophil recovery. IRIS is common and occurs among both responders and non-responders. Declining GMI values implies IRIS with response and obviates the need for invasive procedures and / or therapy modification while persistent GMI elevation is indicative of IRIS with progressive infection. Serial GMI testing should be performed to guide management and evaluate pts prior to therapy with investigational antifungal agents.

Fluconazole in patients at risk from invasive aspergillosis

1993 ◽  
Vol 31 (3) ◽  
pp. 259-261 ◽  
Author(s):  
R. Kappe ◽  
K.J. Osterziel ◽  
R. Rüchel ◽  
S. Siehl
Keyword(s):  
At Risk ◽  
Invasive Aspergillosis ◽  
Patients At Risk
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