Diagnosing fungal infections in immunocompromised hosts.

Tang, Christoph M.; Cohen, Jesse D.

doi:10.1136/jcp.45.1.1

Cited by 40 publications

(12 citation statements)

References 55 publications

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“…Mortality is approximately 60 % (8,9), although this figure can be reduced by early diagnosis and treatment (10,11). Diagnosis, however, is frequently hampered and delayed for several reasons (1,2,12,13). Neither clinical symptoms nor results of radiological examinations are distinctive.…”

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confidence: 94%

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Aspergillus antigenuria compared to antigenemia in bone marrow transplant recipients

Ansorg

Heinegg²,

Rath³

1994

Eur. J. Clin. Microbiol. Infect. Dis.

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The detection of galactomannan antigen in urine was investigated in 26 bone marrow transplant recipients using an Aspergillus latex agglutination test (Pastorex). After modification of the method, which was originally devised for serum testing, the detection limit in native urine was approximately 20 ng/ml. Antigen was found in 79 (36.4%) of 217 serial urine samples, compared to 40 (11.8%) of 340 serum samples. As a rule, antigenuria preceded antigenemia and was more persistent. The sensitivity, specificity, positive predictive value and negative predictive value of antigenuria for autopsy-proven aspergillosis and clinically suspected Aspergillus infection were 57%, 53%, 31% and 77%, respectively, while those of antigenemia were 43%, 53%, 25% and 71%. It is concluded that urine testing is more reliable than serum testing for the detection of Aspergillus galactomannan. The detection of antigen, however, whether in serum or in urine, allows no clear distinction between Aspergillus infection and exposure to non-infectious Aspergillus antigens.

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confidence: 94%

“…The unsatisfactory predictive value of antibody detection has prompted the development of immunoassays for Aspergillus antigen (2,13,15). Galactomannan and glycoproteins are the major circulating antigens in invasive aspergillosis.…”

mentioning

confidence: 99%

Aspergillus antigenuria compared to antigenemia in bone marrow transplant recipients

Ansorg

Heinegg²,

Rath³

1994

Eur. J. Clin. Microbiol. Infect. Dis.

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“…Studies have shown that sputum samples that are positive for Aspergillus in patients with leukaemia, or in those who have undergone HSCT, have a positive predictive value of 80-90% [66,68,69]. Conversly, negative sputum samples do not rule out IPA; negative sputum studies have been noted in 70% of patients with confirmed IPA [69,70]. Blood cultures are rarely positive in patients with confirmed IPA [71].…”

Section: Diagnosismentioning

confidence: 99%

Pulmonary aspergillosis: a clinical review

Kousha¹,

Tadi²,

Soubani³

2011

Eur Respir Rev

599

596

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Aspergillus is a mould which may lead to a variety of infectious, allergic diseases depending on the host's immune status or pulmonary structure. Invasive pulmonary aspergillosis occurs primarily in patients with severe immunodeficiency. The significance of this infection has dramatically increased with growing numbers of patients with impaired immune state associated with the management of malignancy, organ transplantation, autoimmune and inflammatory conditions; critically ill patients and those with chronic obstructive pulmonary disease appear to be at an increased risk. The introduction of new noninvasive tests, combined with more effective and better-tolerated antifungal agents, has resulted in lower mortality rates associated with this infection. Chronic necrotising aspergillosis is a locally invasive disease described in patients with chronic lung disease or mild immunodeficiency. Aspergilloma is usually found in patients with previously formed cavities in the lung, whereas allergic bronchopulmonary aspergillosis, a hypersensitivity reaction to Aspergillus antigens, is generally seen in patients with atopy, asthma or cystic fibrosis. This review provides an update on the evolving epidemiology and risk factors of the major manifestations of Aspergillus lung disease and the clinical manifestations that should prompt the clinician to consider these conditions. Current approaches for the diagnosis and management of these syndromes are discussed.

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“…does not exclude an invasive pulmonary aspergillosis diagnosis since negative sputum studies have been noted in 70% of patients with confirmed invasive pulmonary aspergillosis. 2 Procedures such as CT scans, blood cultures and special culture media, which should be performed during diagnosis, are of limited value in confirming an etiology of fungal infection. However, none of these noninvasive tests should replace direct pulmonary investigation.…”

Section: Discussionmentioning

confidence: 99%