The Utility of Serum Galactomannan Assay for the Diagnosis of Invasive Aspergillosis in Children with Acute Lymphoblastic Leukemia

• Published in: International journal of infectious diseases 2017-01, Vol.54 (C), p.8-12
• Main Authors: Avcu, Gulhadiye, Karapinar, Deniz Yilmaz, Akinci, Ayse Burcu, Sivis, Zuhal Onder, Sahin, Akkiz, Bal, Zumrut Sahbudak, Polat, Suleyha Hilmioglu, Metin, Dilek Yesim, Vardar, Fadil, Aydinok, Yesim
• Format: Article
• Language: English
• Subjects: Acute lymphoblastic leukemia; Adolescent; Aspergillosis; Child; Child, Preschool; Children; False-positive; Female; Galactomannan; Humans; Infant; Infectious Disease; Invasive Pulmonary Aspergillosis - blood; Invasive Pulmonary Aspergillosis - diagnosis; Invasive Pulmonary Aspergillosis - etiology; Invasive Pulmonary Aspergillosis - microbiology; Male; Mannans - blood; Precursor Cell Lymphoblastic Leukemia-Lymphoma - complications; Pulmonary/Respiratory; Retrospective Studies; Sensitivity and Specificity; True-positive
• ISSN: 1201-9712; 1878-3511
• DOI: 10.1016/j.ijid.2016.10.027

Abstract Objectives Invasive aspergillosis (IA) is an important cause of mortality and morbidity in children with hematologic malignancies. Monitoring of serum galactomannan (GM) antigen is considered to be indicative of IA. In this study, our aim was to determine the utility of serum GM monitoring in the early diagnosis of IA and the role of a positive antigenemia in the management in children with acute lymphoblastic leukemia (ALL). Methods Between January 2006 and February 2015, 141 children who were treated for ALL at the Pediatric Hematology Department of the Medical School of Ege University were retrospectively reviewed. Cases of proven and probable IA were defined according to European Organization for the Research and Treatment of Cancer/Mycoses Study Group (EORTC/MSG) criteria. Results The proven and probable IA incidence was 5/141 (3.5%). Among 3,264 serum samples, the incidence of positive GM antigenemia was 5.5% (n = 179). Of the patients, 21.7% were true positive, 52.1% were false positive, and the remaining 26.1% were classified as “undetermined.” An increase in both in the incidence of true-positive tests and antifungal therapy induction was determined through multiple consecutive positive tests. Conclusions GM may be detected in serum before the clinical signs of IA but its sensitivity and specificity is variable. False-positivity is a significant disadvantage, consecutive positive GM must be taken into account in case of clinical and imaging findings that are relevant to IA.