Utility of a serum Aspergillus galactomannan assay in diagnosis of invasive pulmonary Aspergillosis in HIV/AIDS patients: a prospective analysis

  • Ravinder Kaur Department of Microbiology, Lady Hardinge Medical College and Associated Kalawati Saran Children Hospital, New Delhi-110001, India
  • Bhanu Mehra Department of Microbiology, Dr. Baba Saheb Ambedkar Medical College and Hospital, New Delhi-110085, India
  • Megh Singh Dhakad Department of Microbiology, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi-110002, India
  • Ritu Goyal Department of Microbiology, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi-110002, India
  • Preena Bhalla Department of Microbiology, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi-110002, India
  • Richa Dewan Department of Medicine, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi- 110002, India
Keywords: galactomannan, HIV/AIDS, invasive pulmonary aspergillosis, serum

Abstract

Background: Invasive pulmonary aspergillosis (IPA) is a life threatening infection among immunocompromised patients. A timely and precise diagnosis of this condition is often precluded by lack of sensitive and specific noninvasive diagnostic tools. Detection of galactomannan has emerged as a promising tool in this regard. While the analytical performance of serum galactomannan assay has been extensively evaluated in various high risk groups, its possible utility in HIV/AIDS patients is yet to be explored. The present study was undertaken to evaluate the yield of a serum galactomannan assay for diagnosis of IPA in a cohort of HIV/AIDS patients.Methods: 49 febrile HIV reactive patients with co-existent symptomatic AIDS were prospectively enrolled for the evaluation. Blood samples were drawn from each patient and serum galactomannan screening was performed employing the commercially available serum galactomannan assay, Platelia™ Aspergillus EIA. An optical density index >0.5 for at least two serum samples was considered the defining criteria for a positive result. Furthermore, sputum samples were collected and direct microscopic examination (10% potassium hydroxide wet mount) and fungal cultures were performed.Result: In accordance with the definitions laid down under EORTC/MSG (European Organization for Research and Treatment of Cancer / Mycoses Study Group) criteria, ten cases of probable and 23 cases of possible IPA were diagnosed. The sensitivity, specificity, and positive and negative predictive values of Platelia™ Aspergillus EIA for patients with probable IPA were 90%, 100%, 100% and 94.12 % respectively.Conclusion: Serum galactomannan assay has a high sensitivity and specificity and when complemented with relevant lower respiratory tract symptomatology and imaging findings, can serve as a useful adjunct to conventional modalities for the diagnosis of IPA in HIV/AIDS patients. DOI: 10.21276/APALM.1439

Author Biographies

Ravinder Kaur, Department of Microbiology, Lady Hardinge Medical College and Associated Kalawati Saran Children Hospital, New Delhi-110001, India
Director Professor, Department of Microbiology, Lady Hardinge Medical College and Associated Kalawati Saran Children Hospital, New Delhi-110001, India
Bhanu Mehra, Department of Microbiology, Dr. Baba Saheb Ambedkar Medical College and Hospital, New Delhi-110085, India
Assistant Professor, Department of Microbiology, Dr. Baba Saheb Ambedkar Medical College and Hospital, New Delhi-110085, India
Megh Singh Dhakad, Department of Microbiology, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi-110002, India
Research Scholar, Department of Microbiology, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi-110002, India
Ritu Goyal, Department of Microbiology, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi-110002, India
Research Associate, Department of Microbiology, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi-110002, India
Preena Bhalla, Department of Microbiology, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi-110002, India
Director Professor, Department of Microbiology, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi-110002, India
Richa Dewan, Department of Medicine, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi- 110002, India
Director Professor, Department of Medicine, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi- 110002, India

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Published
2017-10-24
Section
Original Article