title: Application of nucleic acid sequence-based amplification for diagnosis of and monitoring the clinical course of invasive aspergillosis in patients with hematologic diseases.
abstract: METHODS
  We evaluated nucleic acid sequence-based amplification (NASBA) and a galactomannan enzyme immunosorbent assay (GM-EIA) for the diagnosis of invasive aspergillosis (IA) in neutropenic febrile patients and for monitoring of its clinical course and outcome. Blood samples were collected twice per week from 128 patients with hematologic diseases during periods of neutropenic fever after undergoing chemotherapy or hematopoietic stem cell transplantation. A total of 448 blood samples were tested.
  
  
  RESULTS
  There were 14 patients with IA (2 patients with proven IA and 12 with probable IA). The median index of the initial NASBA in the IA group was more than 10-fold higher than that in the non-IA group. Galactomannan antigenemia (index, >0.5) was detected with a sensitivity of 86%. In receiver-operator characteristic analysis, the cutoff index of NASBA for the presumptive diagnosis of IA was determined to be 5.0. Combination of these 2 parameters (either a GM-EIA index of >or=0.5 or a NASBA index of >or=5.0) improved the sensitivity of diagnosis to 100%. There was a close relationship between patient outcome and the kinetics of NASBA values: failure of negative conversion during treatment resulted in death in almost all cases.
  
  
  CONCLUSIONS
  If either GM-EIA or NASBA results suggest IA, the diagnostic yield for IA could be improved, and NASBA could be a useful marker for predicting the clinical course and outcome of treatment.
authors.affiliation: Department of Internal Medicine, Division of Infectious Diseases, The Catholic Hematopoietic Stem Cell Transplantation Center, The Catholic University of Korea College of Medicine, Seoul, South Korea. mogulkor@medimail.co.kr
authors.forename: Jin-Hong
authors.initials: JH
authors.lastname: Yoo
authors.forename: Jung-Hyun
authors.initials: JH
authors.lastname: Choi
authors.forename: Su-Mi
authors.initials: SM
authors.lastname: Choi
authors.forename: Dong-Gun
authors.initials: DG
authors.lastname: Lee
authors.forename: Wan-Shik
authors.initials: WS
authors.lastname: Shin
authors.forename: Woo-Sung
authors.initials: WS
authors.lastname: Min
authors.forename: Chun-Choo
authors.initials: CC
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use; D001228:Aspergillosis / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D005260:Female; D005690:Galactose / Q000031:analogs & derivatives; D006402:Hematologic Diseases / Q000150:complications* / Q000382:microbiology; D006801:Humans; D007124:Immunoenzyme Techniques / Q000379:methods*; D015470:Leukemia, Myeloid, Acute / Q000150:complications; D008172:Lung Diseases, Fungal / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D008297:Male; D008351:Mannans / Q000032:analysis*; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000150:complications; D021141:Nucleic Acid Amplification Techniques / Q000379:methods*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications; D012680:Sensitivity and Specificity
chemical_list: D000935:Antifungal Agents; D008351:Mannans; C012990:galactomannan; D005690:Galactose