Evaluation of the galactomannan assays for the diagnosis of invasive pulmonary aspergillosis in the patients with respiratory disease

Abstract

Abstract: Objective To assess the diagnostic value of detecting aspergillus galatomannan (GM) antigen in the patients with invasive pulmonary aspergillosis (IPA). Methods The asepergillus GM antigen in the sera from 135 patients was detected by enzyme-linked immunosorbent assay (ELISA). The receiver operating characteristic curve (ROC curve) was generated, and the area under the curve was revealed. The sensitivity and the specificity of GM assay were evaluated and the best cut-off value was chosen. Results GM level in the sera from 24 IPA patients （1.37±1.21）was significantly higher than 63 non-IPA patients（0.49±0.18）(F=31.10，P＜0.05). The area under the curve was 0.746 (95% CI=0.621-0.872). When the cut-off value was set at 0.63, the sensitivity and the specificity of GM assay were 66.7% and 73.0% respectively. Conclusion GM assay showed the higher sensitivity and specificity. It is useful for the early diagnosis of IPA.

Key words: Invasive pulmonary aspergillosis, Respiratory tract diseases, Mannans, Enzyme-linked imunosorbent assay

GE Wei, LIU Zhi-min, JIANG Cai-hua, HU Hua, WANG Hai-ying. Evaluation of the galactomannan assays for the diagnosis of invasive pulmonary aspergillosis in the patients with respiratory disease[J]. Chinese Journal of Antituberculosis, 2012, 34(6): 369-373.

References

［1］Bulpa PA, Dive AM, Garrino MG, et al. Chronic obstructive pulmonary disease patients with invasive pulmonary aspergillosis: benefits of intensive care? Intensive Care Med, 2001,27(1):59-67.

［2］Meersseman W, Vandecasteele SJ, Wilmer A, et al. Invasive aspergillosis in critically ill patients without malignancy. Am J Respir Crit Care Med, 2004, 170(6):621-625.

［3］汪长生，杨进孙，都郭蕾. 肺结核并发肺部真菌感染的易感因素分析. 中国防痨杂志，2010，32（7）：380-383.

［4］Vandewoude KH, Blot SI, Benoit D, et al. Invasive aspergillosis in critically ill patients: attributable mortality and excesses in length of ICU stay and ventilator dependence. J Hosp Infect, 2004, 56(4):269-276.

［5］Trof RJ, Beishuizen A, Debets-Ossenkopp YJ, et al. Management of invasive pulmonary aspergillosis in non-neutropenic critically ill patients. Intensive Care Med, 2007, 33(10):1694-1703.

［6］叶梦华，张忠顺，杨妍，等. 耐多药肺结核继发肺部真菌感染51例临床分析.中国防痨杂志，2009，31（12）：693-696.

［7］Clancy CJ, Jaber RA, Leather HL, et al. Bronchoalveolar lavage galactomannan in diagnosis of invasive pulmonary aspergillosis among solid organ transplant recipients. J Clin Microbiol, 2007, 45(6):1759-1765.

［8］Maertens J, Maertens V, Theunissen K, et al. Bronchoalveolar lavage fluid galactomannan for the diagnosis of invasive pulmonary aspergillosis in patients with hematologic diseases. Clin Infect Dis, 2009, 49(11):1688-1693.

［9］Mennink-Kersten MA, Donnelly JP, Verweij PE. Detection of circulating galactomannan for the diagnosis and management of invasive aspergillosis. Lancet Infect Dis, 2004, 4(6):349-357.

［10］Park SY, Lee SO, Choi SH, et al. Aspergillus galactomannan antigen assay in bronchoalveolar lavage fluid for diagnosis of invasive pulmonary aspergillosis. J Infect, 2010,61(6):492-498.

［11］中华内科杂志编辑委员会. 侵袭性肺部真菌感染的诊断标准与治疗原则(草案). 中华内科杂志，2006，45(8)：697-700.

［12］Becker MJ, Lugtenburg EJ, Cornelissen JJ, et al. Galactomannan detection in computerized tomography-based broncho-alveolar lavage fluid and serum in hematological patients at risk for invasive pulmonary aspergillosis. Br J Haematol, 2003, 121(3):448-457.

［13］Hope WW, Walsh TJ, Denning DW. Laboratory diagnosis invasive aspergillosis. Lancet Infect Dis, 2005, 5(10): 609-622.

［14］金欣，陈建魁，于农，等. 曲霉半乳甘露聚糖检测对侵袭性曲霉病早期诊断的实验研究. 中国误诊学杂志，2008，8（1）：7-9.

［15］Maertens J, Verhaegen J, Demuynck H,et al. Autopsy-controlled prospective evaluation of serial screening for circulating galactomannan by a sandwich enzyme-linked immunosorbent assay for hematological patients at risk for invasive aspergillsois. J Clin Microbiol, 1999, 37(10): 3223-3228.

［16］Sulahian A, Boutboul F, Ribaud P, et al. Value of antigen detection using an enzyme immunoassay in the diagnosis and prediction of invasive aspergillosis in two adult and pediatric hematology units duiring a 4-year prospective study. Cancer, 2001, 91(2): 311-318.

［17］Verweij PE, Stynen D, Rijs AJ, et al. Sandwich enzyme-linked immunosorbent assay compared with Pastorex latex agglutination test for diagnosing invasive aspergillosis in immunocompromised patients. J Clin Microbiol, 1995, 33(7): 1912-1914.

［18］Fortun J, Martin-Davila P, Alvarez ME et al. Aspergillus antigenemia sandwich-enzyme immunoassay test as a serodiagnostic method for invasive aspergillosis in liver transplant recipients. Transplantation, 2001, 71(1): 145-149.

［19］Kitasato Y, Tao Y, Hoshino T, et al. Comparison of Aspergillus galactomannan antigen testing with a new cut-off index and Aspergillus precipitating antibody testing for the diagnosis of chronic pulmonary aspergillosis. Respirology, 2009, 14(5):701-708.

［20］Husain S, Kwak EJ, Obman A, et al. Prospective assessment of Platelia Aspergillus galactomannan antigen for the diagnosis of invasive aspergillosis in lung transplant recipients. Am J Transplant, 2004, 4(5): 796-802.

［21］Bretagne S, Costa JM, Bart-Delabesse E, et al. Comparison of serum galactomannan antigen detection and competitive polymerase chain reaction for diagnosing invasive aspergillosis. Clin Infect Dis, 1998, 26(6): 1407-1412.

［22］Walsh TJ, Schaufele RL, Sein T, et al. Reduced expression of galactomannan antigenemia in patients with invasive aspergillosis and chronic granulomatous disease or Job’s syndrome//Infectious Diseases Society of America. Program and abstracts of the 40th Annual Meeting of the Infectious Diseases Society of America. Chicago：Infectious Diseases Society of America, 2002.

［23］Verweij PE, Weemaes CM, Curfs JH, et al. Failure to detect circulating Aspergillus markers in patients with chronic granulomatous disease and invasive aspergillosis. J Clin Microbiol, 2000, 38(10): 3900-3901.

［24］Maertens J, Theunissen K, Verbeken E, et al. Prospective clinical evaluation of lower cut-offs for galactomannan detection in adult neutropenic cancer patients and haematological stem cell transplant recipients. Br J Haematol, 2004, 126(6): 852-860.

［25］Glimp RA, Bayer AS. Pulmonary aspergilloma: diagnostic and therapeutic considerationg. Arch Intern Med,1983, 143(2):303-308.

［26］Park SY, Lee SO, Choi SH, et al. Serum and bronchoalveolar lavage fluid galactomannan assays in patients with pulmonary aspergilloma. Clin Infect Dis, 2011, 52(7):149-152.

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