Utility of Galactomannan Enzyme Immunoassay and (1,3) β-d-Glucan in Diagnosis of Invasive Fungal Infections: Low Sensitivity for Aspergillus fumigatus Infection in Hematologic Malignancy Patients

DOI: 10.1128/JCM.00506-08

Article Figures & Data

TABLE 1.

Demographic characteristics of case patients and negative control patients by infection type

Characteristic	No. (%) of patients^a
Characteristic	Aspergillosis (n = 22)	Candida infection (n = 23)	Other mold infection (n = 17)
Gender
No. of males	16 (73)	12 (52)	9 (53)
No. of females	6 (27)	11 (48)	8 (47)
Age (yr) (median [range])	60 (10-78)	55 (23-81)	51 (22-73)
Underlying disease
Hematological	22 (100)	11 (48)	17 (100)
Solid tumor	0 (0)	12 (52)	0 (0)
Bone marrow transplantation	12 (55)	2 (9)	9 (53)
Allogeneic hematopoietic stem cell transplant donor type	12 (55)	2 (9)	7 (41)
Site of IFI
Lung	21 (96)		4 (23)
Sinus	1 (5)		5 (29)
Blood		23 (100)	2 (12)
Skin			6 (35)
Antifungal therapy	22 (100)	21 (91)	17 (100)
Graft-versus-host disease	8 (36)	1 (4)	5 (29)
Neutropenia during prior mo	12 (55)	9 (39)	9 (53)
Neutropenia at infection onset	5 (23)	6 (26)	6 (35)
Use of steroids before infection	15 (68)	9 (39)	11 (65)
Use of steroids during infection	17 (77)	9 (39)	11 (65)
Immunotherapy	18 (82)	10 (44)	13 (77)
White blood cell count	2 (9)	2 (9)	4 (24)
Granulocyte-macrophage colony-stimulating factor	4 (18)	2 (9)	4 (24)
Granulocyte colony-stimulating factor	16 (73)	9 (39)	12 (71)
Gamma interferon	1 (5)	1 (4)	6 (35)
Breakthrough	20 (91)	11 (48)	13 (77)

↵a Data represent numbers (percentages) of patients except where otherwise indicated.

TABLE 2.

Performances of diagnostic tests for patients with IFI (per sample and per patient)

Type of comparison and IFI	Assay	Sensitivity (%)	Specificity (%)	PPV (%)^a	NPV (%)^a
Per sample
Aspergillosis (n = 116)	GM	24	99	97	57
	BG	58	88	83	67
Candidemia (n = 102)	GM	2	99	67	54
	BG	61	88	82	72
Other mold infection (n = 77)	GM	6	99	83	62
	BG	47	88	72	72
Per patient
Aspergillosis (n = 22)	GM	38	100	100	61
	BG	67	90	88	72
Candidemia (n = 23)	GM	0	100	NA	49
	BG	62	90	87	69
Other mold infection (n = 17)	GM	6	100	100	57
	BG	63	90	83	75

TABLE 3.

Performances of GM enzyme immunoassay and BG test for patients infected with different organisms (per sample)

Test and organism	Sensitivity (%)	Specificity (%)	PPV (%)^a	NPV (%)^a
GM enzyme immunoassay
A. fumigatus (n = 69)	13	99	90	66
Non-fumigatus Aspergillus species (n = 39)	49	99	95	86
Other mold (n = 77)	6	99	83	62
BG test
A. fumigatus (n = 69)	61	88	75	79
Non-fumigatus Aspergillus species (n = 39)	64	88	64	88
Other mold (n = 76)	47	88	72	72