Diagnostic Utility of Galactomannan Enzyme Immunoassay in Invasive Aspergillosis in Pediatric patients with Hematological Malignancy

Abstract

Objective: This study aims to determine the diagnostic utility of GM EIA in IA in terms of sensitivity, speci city, negative predictive value (NPV) and positive predictive values (PPV) at various cut offs while validating the revised EORTC/MSG 2019 criteria.Material and methods: For 100 pediatric patients, serum and respiratory samples were collected. Clinical, mycological workup (potassium-hydroxide mount, fungal culture) and GM EIA was done to classify proven, probable, and possible IA as per EORTC-MSG guidelines,2019. Sensitivity, speci city, PPV and NPV were calculated of GM indices at cut-off 0.5, 0.7 and 1, and validated with revised EORTC -MSG, 2019.Results: Of 100 patients enrolled, 75 were diagnosed with ALL, 14 with AML, two with Hodgkin's, three had non-Hodgkin lymphoma, and six had undifferentiated leukemia. With routine mycological ndings, 51 were classi ed as probable IA, 11 as possible IA, and 38 as no IA. Aspergillus avus was the most prevalent on culture (56.9%, 29/51) followed by A. fumigatus (29%, 15/51) A. niger (7.8%, 4/51), A. terreus (3.9%, 2/51) and A. nidulans (2%, 1/51). GM EIA demonstrated sensitivity 82.3%, speci city 97.4%, PPV 98.1%, and NPV 77.1% at cut-off 0.67 when comparing probable/possible IA v/s no IA groups. The GM EIA had the best sensitivity (82.4%), speci city (81.8%), PPV (95.5%), and NPV (50%) at cut off 0.78 when the probable IA group was compared to the possible IA. Seven patients succumbed of whom 5 had GMI ≥2. Conclusion:This study deduces the optimal cut off for serum GM EIA to be 0.725 and reinforces the de nition of probable category of EORTC-MSG criteria, 2019. GM EIA when performed adjunctive to clinico-radiological ndings can prove to be screening, diagnostic and prognostic test for IA in paediatric hematological malignancy patients.

Is there still a place for serum galactomannan in the diagnosis of invasive aspergillosis in children at high risk and under antifungal prophylaxis?

“…Das et al deduced an optimal cut-off of 0.67 among 100 children with hematologic malignancies. 31 They also reported very good sen- TA B L E 3 Clinical performance of serum galactomannan in proven and probable invasive aspergillosis.…”

“…Das et al. deduced an optimal cut‐off of 0.67 among 100 children with hematologic malignancies 31 . They also reported very good sensitivity and NPV for a threshold of 0.5.…”