Prospective sandwich enzyme-linked immunosorbent assay for serum galactomannan: early predictive value and clinical use in invasive aspergillosis.
BACKGROUND
The delay between the onset of invasive aspergillosis and the start of antifungal therapy is crucial for the patient's recovery. Early diagnosis is difficult in cancer patients through lack of precocious specific signs. We have investigated the clinical usefulness of circulating Aspergillus antigen monitoring in pediatric hematology patients with a new sensitive sandwich enzyme-linked immunosorbent assay.


METHODS
A prospective study was conducted by assessing circulating galactomannan levels in high risk patients. Thirty-seven patients studied during an 18-month period were evaluated twice weekly during neutropenic phases with the sandwich enzyme-linked immunosorbent assay for serum Aspergillus galactomannan.


RESULTS
Twelve patients had one or more episodes of positive circulating galactomannan detection, 10 of whom developed presumptive invasive aspergillosis. The clinical and radiologic signs occurred at a mean of 13.4 days (range, 0 to 48) after circulating galactomannan detection and reversed in 6 patients treated with amphotericin B at the same time circulating galactomannan detection became negative. Reappearance of circulating galactomannan was observed during subsequent neutropenic periods in 3 patients.


CONCLUSIONS
The detection of galactomannan at concentrations as low as 1 ng/ml can be useful for the early initiation of antifungal therapy and monitoring treatment in clinically documented lung aspergillosis. This technique coupled with chest computed tomography could help to restrict the need of invasive diagnostic procedures in fragile patients.
Rohrlich
P
P
Service d'Hématologie-Immunologie, Hôpital Robert Debré Paris, France.
Sarfati
J
J
Mariani
P
P
Duval
M
M
Carol
A
A
Saint-Martin
C
C
Bingen
E
E
Latge
J P
JP
Vilmer
E
E
D000293:Adolescent; D000946:Antigens, Fungal / Q000097:blood / Q000276:immunology*; D001228:Aspergillosis / Q000150:complications / Q000276:immunology*; D001230:Aspergillus / Q000276:immunology*; D002648:Child; D002675:Child, Preschool; D004797:Enzyme-Linked Immunosorbent Assay / Q000379:methods*; D005500:Follow-Up Studies; D005690:Galactose / Q000031:analogs & derivatives; D006801:Humans; D008351:Mannans / Q000097:blood / Q000276:immunology*; D009894:Opportunistic Infections / Q000150:complications / Q000276:immunology*; D011237:Predictive Value of Tests; D011446:Prospective Studies
D000946:Antigens, Fungal; D008351:Mannans; C012990:galactomannan; D005690:Galactose