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Journal of Clinical Microbiology, January 2005, p. 299-305, Vol. 43, No. 1
0095-1137/05/$08.00+0     doi:10.1128/JCM.43.1.299-305.2005
Copyright © 2005, American Society for Microbiology. All Rights Reserved.

Contribution of (1->3)-ß-D-Glucan Chromogenic Assay to Diagnosis and Therapeutic Monitoring of Invasive Aspergillosis in Neutropenic Adult Patients: a Comparison with Serial Screening for Circulating Galactomannan

Carmen Pazos,1* José Pontón,2 and Amalia Del Palacio1

Unidad de Micología, Departamento de Microbiología, Hospital Universitario 12 de Octubre, Madrid,1 Departamento de Inmunología, Microbiología y Parasitología, Facultad de Medicina y Odontología, Universidad del País Vasco, Bilbao, Vizcaya Spain2

Received 8 July 2004/ Returned for modification 4 August 2004/ Accepted 18 September 2004

Two noninvasive diagnostic tests, (1->3)-ß-D-glucan (BG) (Glucatell) and galactomannan (GM) (Platelia Aspergillus), were used retrospectively in a twice-weekly screening for the diagnosis of invasive aspergillosis (IA) in 40 treatment episodes (one hospital visit per patient) in 40 neutropenic adult patients at high risk for IA. Five proven IA cases, three probable IA cases, and three possible IA cases were diagnosed. Diagnostic levels of both BG and GM were detected in 100% of patients with proven IA cases and in 66% of patients with probable IA cases. The kinetics of both markers in patients with IA were similar. The sensitivity, specificity, and positive and negative predictive values for GM and BG were identical, namely, 87.5, 89.6, 70, and 96.3%, respectively. False-positive reactions occurred at a rate of 10.3% in both tests, but the patients showing false-positive results were different in each test. Both tests anticipated the clinical diagnosis, computed tomography abnormalities, and the initiation of antifungal therapy in most patients, but BG tended to become positive earlier than GM. A combination of the two tests improved the specificity (to 100%) and positive predictive value (to 100%) of each individual test without affecting the sensitivity and negative predictive values. In conclusion, BG and GM detection are useful tests for the diagnosis of IA in high-risk hematological patients, but a combination of the two tests was very useful to identify false-positive reactions by each test.

* Corresponding author. Mailing address: Unidad de Micología, Departamento de Microbiología, Hospital Universitario 12 de Octubre, Avenida de Córdoba s/n, 28041 Madrid, Spain. Phone: 34-91-390-8239. Fax: 34-91-565-2765. E-mail: pazos.c{at}terra.es.

Journal of Clinical Microbiology, January 2005, p. 299-305, Vol. 43, No. 1
0095-1137/05/$08.00+0     doi:10.1128/JCM.43.1.299-305.2005
Copyright © 2005, American Society for Microbiology. All Rights Reserved.



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