Distribution of Galactomannan antigen in BAL and serum samples among Aspergillus isolates and its correlation with culture among Immunocompetent and Immunocomporomised patients in Aligarh region, a north India town
Keywords:
galactomannan antigen, Bronchoalveolar lavage, immunocompetent and immunocompromised
Abstract
Background: Aspergillosis is one of the most common fungal infection among both general patients and immunocompromised individuals. Methods: The study was carried out on 2 groups of patients: immunocompetent and immunocompromised comprising of a total of 90 patients. Microscopy, culture, identification of isolates was done and some specialised tests on serum and BAL for antigen detection were performed. Result: Most of the patients i.e., 47 (31.3%) were between 31-40 years with a mean age of 32.5 years. The male to female ratio was 1.8:1. Galactomannan antigen was positive in 13 (28.9%) BAL samples and in 15 (33.3%) serum samples wherein the 45 BAL samples represented immunocompetent cases and 45 serum samples represented immunocompromised cases. Sensitivity and specificity of GM assay in BAL samples were found to be 100% and 97% respectively. On the other hand, sensitivity and specificity in serum samples were found to be 94.1% and 100% respectively. All patients were categorized into 4 categories as proven IPA, probable IPA, possible IPA and non-IPA. 22 (24.4%) patients were of proven invasive pulmonary aspergillosis (IPA), 7 (7.8%) of probable IPA, 2 (2.2%) belonged to possible IPA while 59 (65.5%) were of non IPA. All of the cases of proven IPA were positive on culture. Conclusion: GM assay in BAL is a very sensitive and specific marker for Aspergillosis while in case of serum samples it is somewhat lesser sensitive.References
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34. Fekkar A, Brun S, D’Ussel M, Uzunov M, Cracco C, Dhedin N, et al. Serum cross-reactivity with Aspergillus galactomannan and cryptococcal antigen during fatal disseminated Trichosporon dermatis infection. Clin Infect Dis 2009;49(9):1457-8.
35. De Pauw B, Walsh TJ, Donnelly JP, Stevens DA, Edwards JE, Calandra T, et al. Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group. Clin Infect Dis 2008;46:1813 21.
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37. Pfeiffer CD, Fine JP, Safdar N. Diagnosis of invasive aspergillosis using a galactomannan assay: a meta-analysis. Clin Infect Dis 2006;42:1417-1427.
2. Aquino SL, Kee ST, Warmock ML, Gamsu G. Pulmonary aspergillosis: imaging findings with pathologic correlation. AJR Am J Roentgenol. 1994 Oct;163(4):811-5.
3. Sobonya RE. Fungal diseases, including allergic bronchopulmonary aspergillosis. In: Thurlbeck WM, Churg AM, eds. Pathology of the lung, 2nd ed. New York: Thieme 1995: 303-308.
4. Thompson BH, Stanford W, Galvin JR, Kuribara Y. Varied radiologic appearances of pulmonary aspergillosis. RadioGraphics 1995; 15(6):1273-1284
5. Miller WT. Aspergillosis: a disease with many faces. Semin Roentgenol 1996 Jan;31(1):52-66.
6. Lamoth F, Alexander BD. Nonmolecular methods for the diagnosis of respiratory fungal infections. Clin Lab Med. 2014 Jun; 34(2):315-36.
7. Mirdha BR, Banerjee U, Sethi S, Samantry JC, Malviya AN. Spectrum of opportunistic fungal and parasitic infections in hospitalized AIDS patients. CARC Calling 1993;6:9–10.
8. Walker PA, White DA. Pulmonary disease. Medical clinics of North America 1996;80:1337-1362.
9. Horré R, Symoens F, Delhaes L, Bouchara JP. Fungal respiratory infections in cystic fibrosis: a growing problem. Med Mycol 2010 Nov;48(Suppl I),S1–3.
10. Fisher MC, Henk DA, Briggs CJ, Brownstein JS, Madoff LC, McCraw SL, et al. Emerging fungal threats to animal, plant and ecosystem health. Nature 2012 Apr 11;484(7393):186–194.
11. Marguet C, Favennec L, Matray O, Bertout S, Giraud S, Couderc L, et al. Clinical and microbiological efficacy of micafungin on Geosmithia argillacea infection in a cystic fibrosis patient. Med Mycol Case Rep 2012;1:79–81.
12. Guarner J, Brandt ME. Histopathologic diagnosis of fungal infections in the 21st century. Clin Microbiol Rev 2011;24:247-280.
13. Mennink-Kersten MA, Donnelly JP, Verweij PE. Detection of circulating galactomannan for the diagnosis and management of invasive aspergillosis. Lancet Infect Dis 2004 Jun;4(6):349-57.
14. Musher B, Fredricks D, Leisenring W, Balajee SA, Smith C, Marr KA. Aspergillus galactomannan enzyme immunoassay and quantitative PCR for diagnosis of invasive aspergillosis with bronchoalveolar lavage fluid. J Clin Microbiol 2004 Dec;42(12):5517-22.
15. Maertens JA, Klont R, Masson C, Theunissen K, Meersseman W, Lagrou K, et al. Optimization of the cutoff value for the Aspergillus double-sandwich enzyme immunoassay. Clin Infect Dis 2007 May 15;44(10):1329-36.
16. CLSI. Method for antifungal disk diffusion susceptibility testing of non-dermatophyte filamentous fungi; Approved Guideline, CLSI document M51-A. Wayne PA. Clinical and Laboratory Standards Institute; 2015.
17. Chander J. Medical Mycology. 3rd edition. 2009; 24: 556-570.
18. Zmeili OS, Soubani AO. Pulmonary aspergillosis: a clinical update. QJM 2007 Jun;100(6):317–34.
19. Maertens JA, Klont R, Masson C, Theunissen K, Meersseman W, Lagrou K, et al. Optimization of the cutoff value for the Aspergillus double-sandwich enzyme immunoassay. Clin Infect Dis 2007 May 15;44(10):1329-36.
20. Stynen D, Goris A, Sarfati J, Latge JP. A new sensitive sandwich enzyme-linked immunosorbent assay to detect galactofuran in patients with invasive aspergillosis. J Clin Microbiol 1995;33(2):497–500.
21. Clancy CJ, Jaber RA, Leather HL, Wingard JR, Staley B, Wheat LJ, et al. Bronchoalveolar lavage galactomannan in diagnosis of invasive pulmonary aspergillosis among solid-organ transplant recipients. J Clin Microbiol 2007;45(6):1759-65.
22. Meersseman W, Lagrou K, Maertens J, Wilmer A, Hermans G, Vanderschuerem S, et al. Galactomannan in bronchoalveolar lavage fluid: a tool for diagnosing aspergillosis in intensive care unit patients. Am J Respir Crit Care Med 2008;177(1):27-34.
23. Luong ML, Clancy CJ, Vadnerkar A, Kwak EJ, Silveira FP, Wissel MC, et al. Comparison of an Aspergillus real-time polymerase chain reaction assay with galactomannan testing of bronchoalvelolar lavage fluid for the diagnosis of invasive pulmonary aspergillosis in lung transplant recipients. Clin Infect Dis 2011;52(10):1218-26.
24. He H, Ding L, Sun B, Li F, Zhan Q. Role of galactomannan determinations in bronchoalveolar lavage fluid samples from critically ill patients with chronic obstructive pulmonary disease for the diagnosis of invasive pulmonary aspergillosis: a propulmonary disease for the diagnosis of invasive pulmonary aspergillosis: a prospective study. Crit Care 2012;16(4):R138.
25. Zhang XB, Chen GP, Lin QC, Lin X, Zhang HY, Wang JH. Bronchoalveolar lavage fluid galactomannan detection for diagnosis of invasive pulmonary aspergillosis in chronic obstructive pulmonary disease. Med Mycol 2013;51(7):688–95.
26. Aubry A, Porcher R, Bottero J, Touratier S, Leblanc T, Brethon B, et al. Occurrence and kinetics of false-positive Aspergillus galactomannan test results following treatment with beta-lactam antibiotics in patients with hematological disorders. J Clin Microbiol 2006;44(2):389-94.
27. Martin-Rabadan P, Gijon P, Alonso Fernandez R, Ballesteros M, Anguita J, Bouza E. False-positive Aspergillus antigenemia due to blood product conditioning fluids. Clin Infect Dis 2012;55(4):e22–7.
28. Hage CA, Reynolds JM, Durkin M, Wheat LJ, Knox KS. Plasmalyte as a cause of false-positive results for Aspergillus galactomannan in bronchoalveolar lavage fluid. J Clin Microbiol 2007;45(2):676-7.
29. Petraitiene R, Petraitis V, Witt JR 3rd, Durkin MM, Bacher JD, Wheat LJ, et al. Galactomannan antigenemia after infusion of gluconate-containing Plasma-Lyte. J Clin Microbiol 2011;49(12):4330–2.
30. Ansorg R, van den Boom R, Rath PM. Detection of Aspergillus galactomannan antigen in foods and antibiotics. Mycoses 1997;40(9-10):353-7.
31. Girmenia C, Santilli S, Ballaro D, Del Diudice I, Armiento D, Mauro FR. Enteral nutrition may cause false-positive results of Aspergillus galactomannan assay in absence of gastrointestinal diseases. Mycoses 2011;54(6):e883-4.
32. Giacchino M, Chiapello N, Bezzio S, Fagioli F, Saracco P, Alfarano A, et al. Aspergillus galactomannan enzymelinked immunosorbent assay cross-reactivity caused by invasive Geotrichum capitatum. J Clin Microbiol 2006;44(9):3432-4.
33. Cummings JR, Jamison GR, Boudreaux JW, Howles MJ, Walsh TJ, Hayden RT. Cross-reactivity of non-Aspergillus fungal species in the Aspergillus galactomannan enzyme immunoassay. Diagn Microbiol Infect Dis 2007;59(1):113-5.
34. Fekkar A, Brun S, D’Ussel M, Uzunov M, Cracco C, Dhedin N, et al. Serum cross-reactivity with Aspergillus galactomannan and cryptococcal antigen during fatal disseminated Trichosporon dermatis infection. Clin Infect Dis 2009;49(9):1457-8.
35. De Pauw B, Walsh TJ, Donnelly JP, Stevens DA, Edwards JE, Calandra T, et al. Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group. Clin Infect Dis 2008;46:1813 21.
36. Ali S, Malik A, Shahid M, Bhargava R. Pulmonary Aspergillosis and Aflatoxins in Chronic Lung disease. Mycopathologia. Aug 2013.
37. Pfeiffer CD, Fine JP, Safdar N. Diagnosis of invasive aspergillosis using a galactomannan assay: a meta-analysis. Clin Infect Dis 2006;42:1417-1427.
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2019-08-28
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