Taghizadeh-Armaki Mojtaba, Hedayati Mohammad T, Moqarabzadeh Vahid, Ansari Saham, Mahdavi Omran Saeed, Zarrinfar Hossein, Saber Sasan, Verweij Paul E, Denning David W, Seyedmousavi Seyedmojtaba
Invasive Fungi Research Center, Mazandaran University of Medical Sciences, Sari, Iran.
Department of Medical Mycology and Parasitology, School of Medicine, Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran.
J Med Microbiol. 2017 Jul;66(7):898-904. doi: 10.1099/jmm.0.000512. Epub 2017 Jul 12.
The detection of galactomannan (GM) in bronchoalveolar lavage (BAL) fluid is an important surrogate marker for the early diagnosis and therapeutic monitoring of invasive aspergillosis (IA), regardless of the involved species of Aspergillus. Here, we utilized the Platelia Aspergillus GM enzyme immunoassay (Bio-Rad) to evaluate the GM index in BAL fluid samples from patients with proven, probable or putative IA due to Aspergillusflavus versus Aspergillusfumigatus.
In a prospective study between 2009 and 2015, 116 BAL samples were collected from suspected IA patients referred to two university hospitals in Tehran, Iran.
According to European Organization for Research and Treatment of Cancer and Mycoses Study Group and Blot criteria, 35 patients were classified as IA patients, of which 33 cases tested positive for GM above 0.5 and, among these patients, 22 had a GM index ≥1. Twenty-eight were culture positive for A. flavus and seven for A. fumigatus. The GM index for A. flavus cases was between 0.5-6.5 and those of A. fumigatus ranged from 1 to 6.5. The sensitivity and specificity of a GM index ≥0.5 in cases with A. flavus were 86 and 88 % and for A. fumigatus patients were 100 and 73 %, respectively.
Overall, the mean GM index in patients with A. fumigatus (3.1) was significantly higher than those of A. flavus (1.6; P-value=0.031) and the sensitivity of GM lower for A. flavus when compared to A. fumigatus. This finding has implications for diagnosis in hospitals and countries with a high proportion of A. flavus infections.
检测支气管肺泡灌洗（BAL）液中的半乳甘露聚糖（GM）是侵袭性曲霉病（IA）早期诊断和治疗监测的重要替代标志物，无论涉及何种曲霉属菌种。在此，我们使用普立泰曲霉GM酶免疫测定法（伯乐公司）评估因黄曲霉与烟曲霉导致的确诊、很可能或疑似IA患者BAL液样本中的GM指数。
在2009年至2015年的一项前瞻性研究中，从转诊至伊朗德黑兰两家大学医院的疑似IA患者中收集了116份BAL样本。
根据欧洲癌症研究与治疗组织和真菌病研究组及印迹法标准，35例患者被分类为IA患者，其中33例GM检测呈阳性，GM值高于0.5，在这些患者中，22例GM指数≥1。28例黄曲霉培养阳性，7例烟曲霉培养阳性。黄曲霉病例的GM指数在0.5 - 6.5之间，烟曲霉病例的GM指数在1至6.5之间。GM指数≥0.5在黄曲霉病例中的敏感性和特异性分别为86%和88%，在烟曲霉患者中分别为100%和73%。
总体而言，烟曲霉患者的平均GM指数（3.1）显著高于黄曲霉患者（1.6；P值 = 0.031），与烟曲霉相比，黄曲霉的GM敏感性较低。这一发现对黄曲霉感染比例较高的医院和国家的诊断具有重要意义。
