Aspergillus antigenuria compared to antigenemia in bone marrow transplant recipients

Ansorg, R.; Heinegg, Evelyn Heintschel von; Rath, Peter‐Michael

doi:10.1007/bf01971310

Cited by 51 publications

(30 citation statements)

References 19 publications

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“…12,13 Therefore, detection of galactomannan has been suggested as a possible diagnostic tool in patients with invasive aspergillosis. 14,17,22 The Pastorex Aspergillus (LA) test has been widely investigated, [23][24][25][26][27] but its performance is controversial because of the wide range of sensitivity (38-95%) reported. In general, the test is considered not to be sensitive enough, although it has been suggested that sensitivity can be increased both by testing consecutive samples during the high risk period 23,28 and by sonicating the serum before testing.…”

Section: Csamentioning

confidence: 99%

Comparison of an enzyme immunoassay and a latex agglutination system for the diagnosis of invasive aspergillosis in bone marrow transplant recipients

Machetti¹,

Feasi

Mordini

et al. 1998

Bone Marrow Transplant

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Summary:The performance of two Aspergillus antigenemia systems, the sandwich enzyme-linked immunosorbent assay (ELISA), Platelia Aspergillus test, and the latex agglutination (LA), Pastorex Aspergillus test, in the diagnosis of invasive aspergillosis were compared by testing 364 serum samples from 22 bone marrow transplant (BMT) recipients. Sensitivity and specificity for the ELISA test were 60% and 82% respectively, vs 40% and 94% for the LA test. In the two patients found positive with both methods, the ELISA test became positive earlier than the LA test or remained positive after the LA test had become negative. These results encourage further evaluation of the Platelia Aspergillus test, to assess its role in the management of invasive aspergillosis in BMT patients. Keywords: invasive aspergillosis; galactomannan; antigen detectionIn recent years, considerable progress has been achieved in the management of bacterial and viral infections in bone marrow transplant (BMT) recipients. By contrast, little progress has been made in the management of fungal infections, especially aspergillosis. 1 This is probably due both to the frequent impossibility of obtaining a reliable diagnosis of aspergillosis at an early stage of the disease and to the relatively poor efficacy of the presently available antifungal armamentarium. As a result, indirect diagnostic methods have received considerable attention in order to overcome these limitations. So far, no method has proven sufficiently sensitive and specific to allow a diagnosis of aspergillosis at an early stage. 2 However, several authors have pointed out that this might be due, at least in part, to how the tests have been used in clinical practice and to the criteria adopted by clinicians in the interpretation of results. 2 A precommercial version of a sandwich enzymelinked immunosorbent assay (ELISA) for detection of cirCorrespondence: C Viscoli, Unità di Malattie dell'Ospite Compromesso, Istituto Nazionale per la Ricerca sul Cancro-Genova, Largo Rosanna Benzi, 10-16132 Genova, Italy Received 22 May 1997; accepted 17 December 1997 culating galactomannan, a polysaccharide component of the fungal cell wall, has been recently described. 3 The test employs the same monoclonal antibody (MoAb) EB-A2 used in the latex agglutination (LA) test (Pastorex Aspergillus; Sanofi Diagnostic, Pasteur, France), but the ELISA system detects galactomannan in serum at a concentration of 1 ng/ml, whereas the LA test has a 15 ng/ml threshold.We have compared sensitivity and specificity of the new ELISA detection system with that of the LA system in the diagnosis of invasive aspergillosis in BMT patients. With the aim of improving the sensitivity and the specificity of the tests, we prospectively collected consecutive serum samples in patients at high risk of aspergillosis, regardless of the presence or absence of clinical symptoms. Patients and methodsDuring a 6-month period, 22 allogeneic BMTs from matched donors, followed at the Bone Marrow Transplant Unit of the Haematology Department of S...

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Section: Csamentioning

confidence: 99%

Comparison of an enzyme immunoassay and a latex agglutination system for the diagnosis of invasive aspergillosis in bone marrow transplant recipients

Machetti¹,

Feasi

Mordini

et al. 1998

Bone Marrow Transplant

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“…In this respect, the detection of Aspergillus galactomannan (GM) in the serum, using a commercially available sandwich enzyme-linked immunosorbent assay (ELISA) (Stynen et al, 1995), has shown promising results Ó 2003 Blackwell Publishing Ltd (Maertens et al, 1999(Maertens et al, , 2001Sulahian et al, 2001). The antigen can also be detected in urine (Dupont et al, 1987;Ansorg et al, 1994) or BAL fluid (Andrews & Weiner, 1982;Verweij et al, 1995a;Salonen et al, 2000). Few studies have compared GM detection in serum and BAL fluid in neutropenic patients (Verweij et al, 1997;Salonen et al, 2000).…”

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confidence: 99%

Galactomannan detection in computerized tomography‐based broncho‐alveolar lavage fluid and serum in haematological patients at risk for invasive pulmonary aspergillosis

Becker¹,

Lugtenburg²,

Cornelissen³

et al. 2003

Br J Haematol

189

123

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Summary. We determined the value of galactomannan (GM) detection in computerized tomography (CT)-based broncho-alveolar lavage (BAL) fluid and serum for the diagnosis of invasive pulmonary aspergillosis (IPA) in haemato-oncological patients with neutropenia. CT of the thorax and BAL were performed systematically at predefined clinical indications. GM was determined by sandwich enzyme-linked immunosorbent assay; the clinicians were unaware of the results. Of 160 patients, 17 patients (10AE6%) presented with proven, probable or suspected IPA. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of GM detection in CT-based BAL fluid were all 100%. For GM detection in serially sampled serum, the sensitivity was 47%, the specificity 93%, the PPV 73% and the NPV 82%. A non-blinded follow-up study was performed to validate these results. In this study, 22 of 198 patients (11AE1%) presented with IPA, and the sensitivity, specificity, PPV and NPV of GM detection in CT-based BAL fluid were 85%, 100%, 100% and 88% respectively. None of BAL fluids obtained after antifungal treatment of 3 d or more were positive. These results indicate that, when CT is used systematically and at an early stage, GM detection in CT-based BAL fluid has a high PPV for diagnosing IPA early in untreated patients.

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“…The test has been validated for serum specimens only and has a detection limit of 1ng/mL, which is 10 to 15 times lower than the limit of the latex agglutination test used previously (Pastorex Aspergillus, Biorad). [73][74][75][76] Circulating galactomannan may be detected at a median of five to eight days before clinical manifestation of aspergillosis. 72,[77][78][79][80] The concentration of circulating galactomannan corresponds with the fungal tissue burden 81,82 and may therefore be used to monitor the response to treatment.…”

Section: N E W D I a G N O S T I C T O O L Smentioning

confidence: 99%

“…69 Although the antigen can be detected in the urine, 73,74,[105][106][107] little is known about its pharmacokinetics and clearance by the kidney. The effect of renal failure or dialysis on the clearance of galactomannan is also indefinite.…”

Section: N E W D I a G N O S T I C T O O L Smentioning

confidence: 99%

“…Little is known regarding the correlation between galactomannan detection in urine and disease progression, and false-positive results may be an important drawback for this test. 69,73,74 Because galactomannan is predominantly released by Aspergillus hyphae during growth and to a much lesser extent by conidia, detection of galactomannan in BAL fluid provides better evidence for aspergillosis than culture 108,109 or polymerase chain reactions (PCRs), which do not discriminate between contamination conidia and hyphae. [110][111][112] However, false positive results may occur in patients only colonised with Aspergillus when BAL is tested, 69 but this can be improved when one combines this method with the high-resolution computed tomography (CT) scan.…”

Section: N E W D I a G N O S T I C T O O L Smentioning

confidence: 99%

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Diagnosis of Invasive Fungal Infections – Current Limitations of Classical and New Diagnostic Methods

Pasqualotto¹,

Denning²

2005

European Oncology &Amp; Haematology

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Aspergillus antigenuria compared to antigenemia in bone marrow transplant recipients

Cited by 51 publications

References 19 publications

Comparison of an enzyme immunoassay and a latex agglutination system for the diagnosis of invasive aspergillosis in bone marrow transplant recipients

Comparison of an enzyme immunoassay and a latex agglutination system for the diagnosis of invasive aspergillosis in bone marrow transplant recipients

Galactomannan detection in computerized tomography‐based broncho‐alveolar lavage fluid and serum in haematological patients at risk for invasive pulmonary aspergillosis

Diagnosis of Invasive Fungal Infections – Current Limitations of Classical and New Diagnostic Methods

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