Abstract
Background: Invasive pulmonary aspergillosis (IPA) is a life threatening infection among immunocompromised patients. A timely and precise diagnosis of this condition is often precluded by lack of sensitive and specific noninvasive diagnostic tools. Detection of galactomannan has emerged as a promising tool in this regard. While the analytical performance of serum galactomannan assay has been extensively evaluated in various high risk groups, its possible utility in HIV/AIDS patients is yet to be explored. The present study was undertaken to evaluate the yield of a serum galactomannan assay for diagnosis of IPA in a cohort of HIV/AIDS patients.Methods: 49 febrile HIV reactive patients with co-existent symptomatic AIDS were prospectively enrolled for the evaluation. Blood samples were drawn from each patient and serum galactomannan screening was performed employing the commercially available serum galactomannan assay, Platelia™ Aspergillus EIA. An optical density index >0.5 for at least two serum samples was considered the defining criteria for a positive result. Furthermore, sputum samples were collected and direct microscopic examination (10% potassium hydroxide wet mount) and fungal cultures were performed.Result: In accordance with the definitions laid down under EORTC/MSG (European Organization for Research and Treatment of Cancer / Mycoses Study Group) criteria, ten cases of probable and 23 cases of possible IPA were diagnosed. The sensitivity, specificity, and positive and negative predictive values of Platelia™ Aspergillus EIA for patients with probable IPA were 90%, 100%, 100% and 94.12 % respectively.Conclusion: Serum galactomannan assay has a high sensitivity and specificity and when complemented with relevant lower respiratory tract symptomatology and imaging findings, can serve as a useful adjunct to conventional modalities for the diagnosis of IPA in HIV/AIDS patients. DOI: 10.21276/APALM.1439
Highlights
Invasive mycoses such as invasive pulmonary aspergillosis (IPA) are a significant cause of mortality and morbidity in the immunosuppressed population.[1,2] In human immunodeficiency virus (HIV) infected persons in particular, the median survival is nearly 3 months following a diagnosis of Invasive pulmonary aspergillosis (IPA). [3]An accurate diagnosis of IPA is a challenge till date
Biomarkers such as serum galactomannan provide a potential adjunct in the diagnosis of IPA
In 2002, galactomannan antigen detection was included as an indirect evidence of a probable invasive fungal disease and has been retained as such in the definition of mycological criteria as described by the updated EORTC/ MSG guidelines published in 2008. [10, 25] The sensitivity and specificity of serum galactomannan assay has been reported to vary across different studies
Summary
Invasive mycoses such as invasive pulmonary aspergillosis (IPA) are a significant cause of mortality and morbidity in the immunosuppressed population.[1,2] In human immunodeficiency virus (HIV) infected persons in particular, the median survival is nearly 3 months following a diagnosis of IPA. [3]An accurate diagnosis of IPA is a challenge till date. Serum Aspergillus Galactomannan Assay in guiding prompt therapeutic management cannot be undermined. This has led to a search for non-invasive and non-culture- based approaches for an early and rapid diagnosis of invasive aspergillosis. Advent of biomarker assays has been a major breakthrough in this regard These tests detect circulating Aspergillus antigens, metabolites or nucleic acid targets as surrogate markers for diagnosing this invasive condition. While the analytical performance of serum galactomannan assay has been extensively evaluated in various high risk groups, its possible utility in HIV/AIDS patients is yet to be explored. The present study was undertaken to evaluate the yield of a serum galactomannan assay for diagnosis of IPA in a cohort of HIV/AIDS patients
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