Weisser M, Rausch C, Droll A, Simcock M, Sendi P, Steffen I, Buitrago C, Sonnet S, Gratwohl A, Passweg J, Fluckiger U
Division of Infectious Diseases and Hospital Epidemiology, University Hospital, Basel, Switzerland.
Clin Infect Dis. 2005 Oct 15;41(8):1143-9. doi: 10.1086/444462. Epub 2005 Sep 12.
Detection of serum galactomannan (GM) antigen and presence of the halo sign on a pulmonary computerized tomographic (CT) scan have a high specificity but a low sensitivity to diagnose invasive aspergillosis (IA) in patients at risk for this disease. To our knowledge, the relationship between the time at which pulmonary infiltrates are detected by CT and the time at which GM antigens are detected by enzyme immunoassay (EIA) has not been studied.
In a prospective study, tests for detection of GM were performed twice weekly for patients with hematological malignancies who had undergone hematopoetic stem cell transplantation (HSCT) or had received induction and/or consolidation chemotherapy. A pulmonary CT scan was performed once weekly. Infiltrates were defined as either major or minor signs. IA was classified as proven, probable, or possible, in accordance with the definition stated by 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.
We analyzed 161 episodes of infection in 107 patients (65 allogeneic HSCT recipients, 30 autologous HSCT recipients, and 66 induction and/or consolidation chemotherapy recipients). A total of 109 episodes with no IA, 32 episodes with possible IA, and 20 episodes with probable or proven IA were identified. Minor pulmonary signs were detected by CT in 70 episodes (43%), and major pulmonary signs were detected by CT in 11 episodes (7%). Univariate and multivariate analyses revealed no significant association between detection of GM by EIA and detection of abnormal pulmonary signs by CT. A significant association was found between GM levels and receipt of piperacillin-tazobactam. GM test results were not positive before major signs were seen on CT images. Only 7 (10%) of 70 patients with minor pulmonary signs had positive GM test results before detection of the greatest pathologic change by CT.
We show that detection of GM by EIA does not precede detection of major lesions by pulmonary CT. In the clinical setting, the decision to administer mold-active treatment should based on detection of new pulmonary infiltrates on CT performed early during infection, rather than on results of EIA for detection of GM.
检测血清半乳甘露聚糖（GM）抗原以及肺部计算机断层扫描（CT）上的晕轮征对诊断侵袭性曲霉病（IA）具有高特异性，但敏感性较低，而IA患者有患此病的风险。据我们所知，CT检测到肺部浸润的时间与酶免疫测定（EIA）检测到GM抗原的时间之间的关系尚未得到研究。
在一项前瞻性研究中，对接受造血干细胞移植（HSCT）或接受诱导和/或巩固化疗的血液系统恶性肿瘤患者每周进行两次GM检测。每周进行一次肺部CT扫描。浸润被定义为主要或次要征象。根据欧洲癌症研究与治疗组织侵袭性真菌感染合作组和美国国立过敏与传染病研究所真菌病研究组规定的定义，IA被分类为确诊、很可能或可能。
我们分析了107例患者的161次感染发作（65例异基因HSCT受者、30例自体HSCT受者和66例诱导和/或巩固化疗受者）。共识别出109次无IA发作、32次可能IA发作和20次很可能或确诊IA发作。CT检测到70次（43%）有轻微肺部征象，11次（7%）有主要肺部征象。单因素和多因素分析显示，EIA检测GM与CT检测异常肺部征象之间无显著关联。发现GM水平与哌拉西林 - 他唑巴坦的使用之间存在显著关联。在CT图像上出现主要征象之前，GM检测结果未呈阳性。在70例有轻微肺部征象的患者中，只有7例（10%）在CT检测到最大病理变化之前GM检测结果呈阳性。
我们表明，EIA检测GM并不先于肺部CT检测到主要病变。在临床环境中，决定给予抗霉菌治疗应基于在感染早期进行的CT上检测到新的肺部浸润，而不是基于EIA检测GM的结果。
