A comprehensive diagnostic approach using galactomannan, targeted β‐d‐glucan, baseline computerized tomography and biopsy yields a significant burden of invasive fungal disease in at risk haematology patients

Abstract

SummaryInvasive fungal disease (IFD) is difficult to diagnose. We investigated the incidence of IFD and risk factors using the revised European Organization for Research and Treatment of Cancer (EORTC) and the Mycoses Study Group (MSG) definitions. Patients (N = 203) undergoing intensive therapy with expected neutropenia ≥10 d were recruited prospectively and followed for a median (range) of 556 (12-730) d. Baseline chest computerized tomography (CT) was performed pre-therapy. Twice-weekly surveillance with galactomannan (GM) was combined with targeted b-D-glucan (BDG) testing on patients with possible IFD or who were GM-positive. Tissue diagnosis was obtained whenever possible. The cumulative incidence of proven/probable IFD among the 202 evaluable cases after 2 years follow-up was 21%, including 14 proven and 30 probable IFDs. Using either GM or BDG as the sole biomarker (plus host and clinical evidence) the apparent overall incidence of proven/probable IFD was 11% and 16%, respectively. Combined GM/BDG detected all biopsy-proven mould IFD. Baseline CT abnormalities were found in 76/202 (38%) patients. Baseline CT abnormalities and Karnofsky score <90, monocytopenia >10 d and bacteraemia were independent risk factors associated with greater than twofold increased IFD risk. This combined diagnostic approach identified a high incidence of IFD and important risk factors in this cohort.

Lateral Flow Assays for the Diagnosis of Invasive Aspergillosis: Current Status

“…Culture-based approaches are important for detection of fungal species and resistance testing; however, they are limited by low sensitivities—in particular during early phases of infection—and long turnaround time [8•]. Significant advances to the field were brought by the introduction of non-cultural diagnostic tests for IA in blood and bronchoalveolar lavage fluid (BALF), including galactomannan antigen (GM) testing [9•, 10 –13], PCR [14••, 15, 16••, 17], and beta- d -glucan (BDG) testing [18–24] in patients at risk [25•, 26, 27, 28•, 29]. In line with the introduction of non-cultural diagnostic tests, the rate of fungal infections diagnosed pre-mortem (versus post-mortem) was shown to increase from 16 to 51% in a large autopsy study [30].…”

Composite biomarker panel for prediction of severity and diagnosis of acute GVHD with T-cell-depleted allogeneic stem cell transplants—single centre pilot study

“…This study is a retrospective analysis of a subset of patients with allogeneic HSCT from the invasive aspergillosis study by Ceesay et al 31 (ClinicalTrials.gov No. NCT00816088; REC no: 08/HA0808/154) with full ethical approval.…”

The Cost of Treating Mucormycosis with Isavuconazole Compared with Standard Therapy in the UK

“…Hospitalization costs (Table 1) were estimated by multiplying the duration of hospital stay by the daily cost of a hematology ward bed [12], as hematology patients were considered to be representative of the patient group that is at risk of mucormycosis [6,34]. For ISAV, the length of hospital stay was set to 19.3 days -the mean duration of initial hospitalization of patients who received ISAV as primary therapy in VITAL.…”