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Combined Galactomannan (GMn), Mannan (Mn), and Anti-Mannan (AMn) for Diagnosis of Invasive Fungal Infections (IFI) in Neutropenic Cancer Patients

Senn, L., Robinson, J.O., Schmidt, S., Knaup, M., Duvoisin, B., Bille, J., Calandra, T. and Marchetti, O. (2005) Combined Galactomannan (GMn), Mannan (Mn), and Anti-Mannan (AMn) for Diagnosis of Invasive Fungal Infections (IFI) in Neutropenic Cancer Patients. In: 45th Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC) 2005, 16 - 19 December 2005, Washington, DC.

Abstract

Background: Invasive aspergillosis (IA) and candidiasis (IC) are life-threatening complications in neutropenic cancer Pts. Diagnosis remains difficult and is often delayed when relying on conventional methods. Detection of fungal antigens and antibodies may speed up diagnosis and facilitate antifungal Rx. The aim of the study was to evaluate the utility of a combined use of GMn, Mn and AMn. Methods: Prospective evaluation of 125 consecutive episodes of neutropenia (median duration 23 d) in Pts with acute leukemia. IFI was diagnosed according to EORTC-MSG criteria. Blood was collected 2x weekly before onset of fever and daily thereafter. GMn, Mn and AMn were measured by ELISA (Platelia® , Bio-Rad). Positive tests defined by 2 consecutive values of GMn > 0.4 or > 0.5 OD Index, of Mn > 0.5 ng/ml and of AMn > 10 AU/ml. Results: 11 IA (3 proven, 8 probable) and 13 IC (1 proven, 12 probable) occurred in 125 neutropenic episodes. 16 samples per episode (3-35) were analyzed over 35 d (17-122).

GMn: sensitivity of 0.4 cut-off was higher than that of 0.5, specificity was similar. Mn/AMn: in 90% of Pts with IC, positive tests preceded clinical diagnosis by a median of 10 d. GMn/Mn/AMn: in 89% of Pts with IFI positivity anticipated conventional diagnosis by a median of 6 d. Conclusions: In neutropenic cancer patients, twice weekly monitoring of GMn/Mn/AMn may facilitate early non-invasive diagnosis of invasive fungal infections.

Item Type: Conference Item
URI: http://researchrepository.murdoch.edu.au/id/eprint/61711
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