Earlier diagnosis of invasive fusariosis with Aspergillus serum galactomannan testing

• Published in: PloS one Vol. 9; no. 1; p. e87784
• Main Authors: Nucci, Marcio, Carlesse, Fabianne, Cappellano, Paola, Varon, Andrea G, Seber, Adriana, Garnica, Marcia, Nouér, Simone A, Colombo, Arnaldo L
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 28-01-2014; Public Library of Science (PLoS)
• Subjects: Antifungal Agents - therapeutic use; Antigens; Aspergillus; Biology; Biomarkers - blood; Blood diseases; Brazil; Cancer; Cross Reactions; Cross-reactivity; Diagnosis; Disease; Early Diagnosis; Fever; Fungal infections; Fungi; Fungicides; Fusariosis; Fusariosis - diagnosis; Fusariosis - drug therapy; Fusarium; Hematology; Humans; Kinetics; Leukemia; Mannans - immunology; Medical diagnosis; Medicine; Neutropenia; Patients; Pediatrics; Prognosis; Reaction kinetics; Retrospective Studies; Sensitivity; Sensitivity and Specificity; Brazil; Rio de Janeiro Brazil
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0087784

Cross-reactivity of Fusarium species with serum galactomannan antigen (GMI) test has been observed. We sought to evaluate if GMI could help to early diagnose invasive fusariosis and to monitor treatment response. We reviewed the records of all patients with invasive fusariosis between 2008 and 2012 in three Brazilian hospitals. We selected patients who had at least 1 GMI test within 2 days before or after the date of the first clinical manifestation of fusariosis, and analyzed the temporal relationship between the first positive GMI test and the date of the diagnosis of invasive fusariosis, and the kinetics of GMI in relation to patients' response to treatment. We also selected 18 controls to determine the sensitivity and specificity of the test. Among 18 patients, 15 (83%) had at least one positive GMI (median 4, range 1-15). The sensitivity and specificity of was 83% and 67%, respectively. GMI was positive before the diagnosis of invasive fusariosis in 11 of the 15 cases (73%), at a median of 10 days (range 3-39), and after the diagnosis in 4 cases. GMI became negative in 8 of the 15 patients; 3 of these 8 patients (37.5%) were alive 90 days after the diagnosis of fusariosis compared with 2 of 7 (29%) who did not normalize GMI (p = 1.0). GMI is frequently positive in invasive fusariosis, and becomes positive before diagnosis in most patients. These findings may have important implications for the choice of antifungal therapy in settings with high prevalence of invasive fusariosis.