False-positive Aspergillus galactomannan antigenaemia after haematopoietic stem cell transplantation

• Published in: Journal of antimicrobial chemotherapy 2008-02, Vol.61 (2), p.411-416
• Main Authors: Asano-Mori, Yuki, Kanda, Yoshinobu, Oshima, Kumi, Kako, Shinichi, Shinohara, Akihito, Nakasone, Hideki, Kaneko, Makoto, Sato, Hiroyuki, Watanabe, Takuro, Hosoya, Noriko, Izutsu, Koji, Asai, Takashi, Hangaishi, Akira, Motokura, Toru, Chiba, Shigeru, Kurokawa, Mineo
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Antibiotics. Antiinfectious agents. Antiparasitic agents; Aspergillosis - diagnosis; Aspergillosis - etiology; Aspergillosis - metabolism; Aspergillus; Aspergillus - metabolism; Biological and medical sciences; Chemotherapy; chronic GVHD; False Positive Reactions; Female; Follow-Up Studies; Fungal infections; gastrointestinal tract; Hematopoietic Stem Cell Transplantation - adverse effects; Hematopoietic Stem Cell Transplantation - trends; Human mycoses; Humans; Infectious diseases; invasive aspergillosis; Male; Mannans - analysis; Mannans - metabolism; Medical sciences; Microbiology; Middle Aged; Miscellaneous mycoses; mucosal damage; Mycoses; Pharmacology. Drug treatments; Retrospective Studies; Stem cells; Transplants & implants
• ISSN: 0305-7453; 1460-2091
• DOI: 10.1093/jac/dkm463

Objectives Although Aspergillus galactomannan (GM) antigen detection is widely applied in the diagnosis of invasive aspergillosis (IA), false-positive reactions with fungus-derived antibiotics, other fungal genera or the passage of dietary GM through injured mucosa are a matter of concern. The aim of this study was to investigate the cumulative incidence and risk factors for false-positive GM antigenaemia. Patients and methods The records of 157 adult allogeneic haematopoietic stem cell transplantation (HSCT) recipients were retrospectively analysed. Episodes of positive GM antigenaemia, defined as two consecutive GM results with an optical density index above 0.6, were classified into true, false and inconclusive GM antigenaemia by reviewing the clinical course. Results Twenty-five patients developed proven or probable IA with a 1 year cumulative incidence of 12.9%, whereas 50 experienced positive GM antigenaemia with an incidence of 32.2%. Among the total 58 positive episodes of the 50 patients, 29 were considered false-positive. The positive predictive value (PPV) was lower during the first 100 days than beyond 100 days after HSCT (37.5% versus 58.8%). Gastrointestinal chronic graft-versus-host disease (GVHD) was identified as the only independent significant factor for the increased incidence of false-positive GM antigenaemia (PPV 0% versus 66.7%, P = 0.02). Conclusions GM antigen results must be considered cautiously in conjunction with other diagnostic procedures including computed tomography scans, especially during the first 100 days after HSCT and in patients with gastrointestinal chronic GVHD.