The Korean journal of internal medicine

The Korean Association of Internal Medicine (대한내과학회)
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Serum galactomannan levels in the diagnosis of invasive aspergillosis

  • Okuturlar, Yildiz (Department of Internal Medicine, Bakirkoy Dr. Sadi Konuk Education and Research Hospital) ;
  • Ozkalemkas, Fahir (Department of Hematology, Uludag University Faculty of Medicine) ;
  • Ener, Beyza (Department of Medical Mycology and Microbiology, Uludag University Faculty of Medicine) ;
  • Serin, Sibel Ocak (Department of Internal Medicine, Umraniye Education and Research Hospital) ;
  • Kazak, Esra (Department of Infectious Diseases and Clinical Microbiology, Uludag University Faculty of Medicine) ;
  • Ozcelik, Tulay (Bone Marrow Transplantation Center, Florence Nightingale Hospital) ;
  • Ozkocaman, Vildan (Department of Hematology, Uludag University Faculty of Medicine) ;
  • Ozkan, Hasan Atilla (Department of Hematology, Yeditepe University Faculty of Medicine) ;
  • Akalin, Halis (Department of Infectious Diseases and Clinical Microbiology, Uludag University Faculty of Medicine) ;
  • Gunaldi, Meral (Department of Oncology, Bakirkoy Dr. Sadi Konuk Education and Research Hospital) ;
  • Ali, Ridvan (Department of Hematology, Uludag University Faculty of Medicine)
  • Received : 2015.02.08
  • Accepted : 2015.06.20
  • Published : 2015.11.01
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Abstract

Background/Aims: In this study, the sensitivity-specificity of galactomannan-enzyme immunoassay (GM-EIA) with a cut-off value of 0.5 for a single, two, or three consecutive positivity in the diagnosis of invasive pulmonary aspergillosis (IPA) in neutropenic patients with hematological malignancy was investigated. Methods: IPA was classified as "proven," "probable," or "possible" as described in the guidelines prepared by the European Organization for Research and Treatment of Cancer and Mycoses Study Group." Serum samples were collected from the patients twice a week throughout their hospitalization. A total of 1,385 serum samples, with an average of 8.3 samples per episode, were examined. Results: Based on the 165 febrile episodes in 106 patients, 80 (48.5%) were classified as IPA (4 proven, 11 probable, 65 possible) and 85 (51.5%) as non-IPA. The sensitivity/specificity was 100%/27.1% for a single proven/probable IPA with the cut of value of GM-EIA ${\geq}0.5$, 86.7%/71.8% for two consecutive positive results, and 73.3%/85.9% for three consecutive positive results. Conclusions: With the galactomannan levels measured twice a week, consecutive sensitivity decreased and specificity increased. Therefore, an increase may be obtained in sensitivity-specificity by more frequent monitoring of GM-EIA starting from the first day of positivity is detected.

Keywords

References

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