Detection of Aspergillus galactomannan by enzyme immunoabsorbent assay in recipients of allogeneic hematopoietic stem cell transplantation: a prospective study.
BACKGROUND
Invasive aspergillosis (IA) has become the leading infectious cause of death after allogeneic hematopoietic stem cell transplantation (allo-HSCT). This is partially because of the lack of a sensitive, specific, and noninvasive diagnostic test. New diagnostic tests for IA, such as the detection of Aspergillus galactomannan antigen (AGA) by sandwich enzyme-linked immunoabsorbent assay (ELISA), have recently been described. This study validates the usefulness of this diagnostic tool in the allo-HSCT setting.


METHODS
From January 1999 to January 2001, all consecutive adult patients undergoing allo-HSCT were prospectively studied with a galactomannan antigenemia assay (ELISA test) twice weekly from admission until death or discharge, and weekly afterward if the patient received immunosuppressive therapy. Proven, probable, and possible IA were defined according to the European Organization for Research and Treatment of Cancer/Mycoses Study Group criteria.


RESULTS
During the 2 years of study, 74 patients underwent an allo-HSCT. A total of 832 serum samples were collected. According to the European Organization for Research and Treatment of Cancer/Mycoses Study Group criteria, it was ascertained that 66 patients did not fulfill any criteria of IA, 2 patients were classified with possible IA, 5 patients were classified with probable IA, and 1 patient was classified with proven IA. Fourteen samples were positive for AGA, all from patients with IA. The sensitivity and specificity of the test were 75% and 100%, respectively. The positive predictive and negative predictive values were 100% and 97%, respectively.


CONCLUSIONS
In this study, AGA detection was clearly related to IA. Although the ELISA test did not have any role in the anticipation of the diagnosis, it clarifies the diagnosis of IA in allo-HSCT.
Rovira
Montserrat
M
Bone Marrow Transplant Unit, Department of Hematology, Postgraduate School of Hematology Farreras-Valentí, Hospital Clinic, University of Barcelona, Spain. mrovira@clinic.ub.es
Jimenéz
Mónica
M
De La Bellacasa
Jorge Puig
JP
Mensa
Josep
J
Rafel
Montserrat
M
Ortega
Mar
M
Almela
Manel
M
Martínez
Carmen
C
Fernández-Avilés
Francesc
F
Martínez
Jose A
JA
Urbano-Ispizua
Alvaro
A
Carreras
Enric
E
Montserrat
Emili
E
D001228:Aspergillosis / Q000175:diagnosis* / Q000209:etiology*; D001230:Aspergillus / Q000302:isolation & purification*; D004797:Enzyme-Linked Immunosorbent Assay / Q000706:statistics & numerical data; D005690:Galactose / Q000031:analogs & derivatives; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D016867:Immunocompromised Host; D008351:Mannans / Q000032:analysis*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D014184:Transplantation, Homologous
D008351:Mannans; C012990:galactomannan; D005690:Galactose