title: Clinical utility and prognostic value of galactomannan in neutropenic patients with invasive aspergillosis.
abstract: Invasive aspergillosis (IA) is a major cause of morbidity and mortality in profoundly neutropenic patients. Delayed diagnosis and therapy may lead to poor outcomes.
  
  
  OBJECTIVE
  The objective of this study was to assess the performance characteristics of the galactomannan (GM) assay in serum and bronchoalveolar lavage specimens for the diagnosis of IA in neutropenic patients with hematological malignancies. We also evaluated the prognostic outcome.
  
  
  METHODS
  A total of 1198 serum samples and 42 BAL from 235 neutropenic patients were tested with a GM elisa platelia test. We used Cox modeling of time to 6- and 12-week mortality for GM level at the time of diagnosis (GM0) and GM decay in the week following diagnosis in proven and probable IA patients with more than two GM values.
  
  
  RESULTS
  There were three proven, 55 probable, and four possible cases of IA. The sensitivity and specificity of the GM test were 96.8% and 82.4% respectively. In BAL samples, sensitivity was 86% and the specificity 93%. BAL GM was more sensitive than microscopy (22.2%) and BAL culture (38.9%). Among patients with proven/probable IA, serum and BAL GM were in agreement for 92.8% of paired samples. The hazard ratio (HR) of GM0 and 1-week GM decay per unit increase in Aspergillus enzyme immunoassay (EIA) was 1.044 (95% CI, 0.738 to 1.476) and 0.709 (95% CI, 0.236 to 2.130) respectively.
  
  
  CONCLUSIONS
  We found good correlation between the GM0 and GM decay combination and outcome of IA patients. The GM is a useful tool for diagnosis and monitoring of IA.
authors.affiliation: Fungal and Parasitic Molecular Biology Laboratory, Sfax School of Medicine, Magida Boulila street, Sfax, Tunisia. ineshadrich@yahoo.fr
authors.forename: I
authors.initials: I
authors.lastname: Hadrich
authors.forename: F
authors.initials: F
authors.lastname: Makni
authors.forename: F
authors.initials: F
authors.lastname: Cheikhrouhou
authors.forename: S
authors.initials: S
authors.lastname: Neji
authors.forename: I
authors.initials: I
authors.lastname: Amouri
authors.forename: H
authors.initials: H
authors.lastname: Sellami
authors.forename: H
authors.initials: H
authors.lastname: Trabelsi
authors.forename: H
authors.initials: H
authors.lastname: Bellaaj
authors.forename: M
authors.initials: M
authors.lastname: Elloumi
authors.forename: A
authors.initials: A
authors.lastname: Ayadi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000627:therapeutic use; D001992:Bronchoalveolar Lavage Fluid / Q000737:chemistry*; D002648:Child; D015331:Cohort Studies; D005260:Female; D005690:Galactose / Q000031:analogs & derivatives; D019337:Hematologic Neoplasms / Q000150:complications; D006801:Humans; D016867:Immunocompromised Host; D007223:Infant; D055744:Invasive Pulmonary Aspergillosis / Q000175:diagnosis* / Q000188:drug therapy; D008297:Male; D008351:Mannans / Q000032:analysis* / Q000097:blood*; D008875:Middle Aged; D009503:Neutropenia / Q000209:etiology / Q000382:microbiology*; D011379:Prognosis; D012680:Sensitivity and Specificity
chemical_list: D000935:Antifungal Agents; D008351:Mannans; C012990:galactomannan; D005690:Galactose