False-positive Aspergillus galactomannan antigenaemia after haematopoietic stem cell transplantation.
OBJECTIVE
Although Aspergillus galactomannan (GM) antigen detection is widely applied in the diagnosis of invasive aspergillosis (IA), false-positive reactions with fungus-derived antibiotics, other fungal genera or the passage of dietary GM through injured mucosa are a matter of concern. The aim of this study was to investigate the cumulative incidence and risk factors for false-positive GM antigenaemia.


METHODS
The records of 157 adult allogeneic haematopoietic stem cell transplantation (HSCT) recipients were retrospectively analysed. Episodes of positive GM antigenaemia, defined as two consecutive GM results with an optical density index above 0.6, were classified into true, false and inconclusive GM antigenaemia by reviewing the clinical course.


RESULTS
Twenty-five patients developed proven or probable IA with a 1 year cumulative incidence of 12.9%, whereas 50 experienced positive GM antigenaemia with an incidence of 32.2%. Among the total 58 positive episodes of the 50 patients, 29 were considered false-positive. The positive predictive value (PPV) was lower during the first 100 days than beyond 100 days after HSCT (37.5% versus 58.8%). Gastrointestinal chronic graft-versus-host disease (GVHD) was identified as the only independent significant factor for the increased incidence of false-positive GM antigenaemia (PPV 0% versus 66.7%, P = 0.02).


CONCLUSIONS
GM antigen results must be considered cautiously in conjunction with other diagnostic procedures including computed tomography scans, especially during the first 100 days after HSCT and in patients with gastrointestinal chronic GVHD.
Department of Hematology and Oncology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
Yuki
Y
Asano-Mori
Yoshinobu
Y
Kanda
Kumi
K
Oshima
Shinichi
S
Kako
Akihito
A
Shinohara
Hideki
H
Nakasone
Makoto
M
Kaneko
Hiroyuki
H
Sato
Takuro
T
Watanabe
Noriko
N
Hosoya
Koji
K
Izutsu
Takashi
T
Asai
Akira
A
Hangaishi
Toru
T
Motokura
Shigeru
S
Chiba
Mineo
M
Kurokawa
D000293:Adolescent; D000328:Adult; D000368:Aged; D001228:Aspergillosis / Q000175:diagnosis / Q000209:etiology / Q000378:metabolism*; D001230:Aspergillus / Q000378:metabolism*; D005189:False Positive Reactions; D005260:Female; D005500:Follow-Up Studies; D005690:Galactose / Q000031:analogs & derivatives; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000639:trends*; D006801:Humans; D008297:Male; D008351:Mannans / Q000032:analysis / Q000378:metabolism*; D008875:Middle Aged; D012189:Retrospective Studies
D008351:Mannans; C012990:galactomannan; D005690:Galactose