Aspergillus galactomannan antigen assay and invasive aspergillosis in pediatric cancer patients and hematopoietic stem cell transplant recipients.

Abstract

BACKGROUND:

Invasive aspergillosis (IA) is a major cause of morbidity and mortality in immunocompromised children. We investigated the usefulness of an Aspergillus galactomannan (GM) antigen assay as a diagnostic tool for IA in pediatric cancer patients and hematopoietic cell transplantation (HCT) recipients.

PROCEDURE:

The GM antigen assay results were analyzed in 749 blood samples from 99 patients. A GM index (GMI) greater than or equal to 0.5 on at least two separate occasions was considered positive. A review of the clinical data was performed for subjects with proven or probable IA.

RESULTS:

Twenty-one of 23 patients with proven or probable IA had positive GM antigen test results (91.3% sensitivity, 95% CI 71.9-98.9; 81.7% specificity, 95% CI 69.6-90.5; P < 0.0001). The false-positive rate was 18.3%. Being younger than 3 years of age, having a solid tumor, and receiving HCT within 4 weeks of the test were statistically significant factors for causing false-positive results (P < 0.05). Among the 23 patients with IA (six proven, 17 probable), 16 (69.6%) had hematological malignancies, five (22.7%) had solid tumors, and two (8.7%) had primary immunodeficiency. Nineteen patients (82.6%) received HCT. The most common clinical site of IA was the lungs (91.3%), and consolidation was the most frequent finding in chest CT scans (36.8%). The mortality at 12 weeks was 43.5%.

CONCLUSIONS:

Having a positive GM assay at least twice is useful in diagnosing IA in pediatric patients with cancer and HCT recipients.

• Authors: Soo-Han Choi, Eun-Suk Kang, Hong Eo, So-Young Yoo, Ji Hye Kim, Keon Hee Yoo, Ki Woong Sung, Hong Hoe Koo, Yae-Jean Kim
• Journal: Pediatric blood & cancer (Pediatr Blood Cancer) Vol. 60 Issue 2 Pg. 316-22 (Feb 2013) ISSN: 1545-5017 [Electronic] United States
• PMID: 23042761 (Publication Type: Journal Article)
• Copyright: Copyright © 2012 Wiley Periodicals, Inc.

Chemical References

• Antigens, Fungal
• Mannans
• galactomannan
• Galactose

Topics

• Adolescent
• Antigens, Fungal (analysis)
• Aspergillosis (diagnosis)
• Child
• Child, Preschool
• False Positive Reactions
• Female
• Galactose (analogs & derivatives)
• Hematologic Neoplasms (complications, microbiology)
• Hematopoietic Stem Cell Transplantation (adverse effects)
• Humans
• Immunoenzyme Techniques (methods)
• Infant
• Male
• Mannans (analysis)
• Sensitivity and Specificity