Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Program in Translational Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Sci Rep. 2024 Nov 26;14(1):29383. doi: 10.1038/s41598-024-80374-6.
Universal antifungal treatment has been recommended among hematology patients during chemotherapy to prevent invasive aspergillosis (IA) in developed countries, but it remains a significant challenge in resource-limited settings. Identifying at-risk individuals could enhance clinical outcomes. A prospective pilot study was conducted at four Thai tertiary care hospitals from April 2021 to January 2023, aiming to assess the correlation and the potential of nasal wash galactomannan (GM) as an IA predictor in hematology patients. It enrolled all patients with acute myeloid leukemia (AML) requiring induction chemotherapy and those admitted for stem cell transplantation (SCT). Nasal wash fluid samples were collected for galactomannan testing and fungal culture to assess Aspergillus spp. colonization before chemotherapy. The study included 34 AML and SCT patients. Among them, 3/34 tested positive for Aspergillus spp. colonization via nasal wash fungal culture. After six months, 18 (52.9%) patients were diagnosed with IA-15/25 patients with AML and 3/9 SCT recipients. The traditional culture did not predict IA, whereas nasal wash fluid galactomannan cutoff value of 0.46 yielded a sensitivity of 40% and a specificity of 80% for predicting probable and possible IA in patients with AML. However, in the subgroup analysis, the test did not reveal any correlation with IA development. More extensive studies are needed to validate the optimal IA risk prediction strategy.
在发达国家，血液学患者在化疗期间已被推荐进行通用抗真菌治疗，以预防侵袭性曲霉病（IA），但在资源有限的环境中，这仍然是一个重大挑战。识别高危个体可以提高临床结果。本前瞻性试点研究于 2021 年 4 月至 2023 年 1 月在泰国四家三级护理医院进行，旨在评估鼻腔冲洗半乳甘露聚糖（GM）作为血液学患者 IA 预测指标的相关性和潜力。它纳入了所有需要诱导化疗的急性髓细胞白血病（AML）患者和接受干细胞移植（SCT）的患者。在化疗前采集鼻腔冲洗液样本进行 GM 检测和真菌培养，以评估曲霉菌属定植情况。本研究纳入了 34 例 AML 和 SCT 患者。其中，3/34 例经鼻腔冲洗真菌培养检测出曲霉菌属定植阳性。6 个月后，18 例（52.9%）患者被诊断为 IA-15/25 例 AML 患者和 3/9 例 SCT 受者。传统培养不能预测 IA，而鼻腔冲洗 GM 截止值为 0.46 时，对 AML 患者的可能和很可能 IA 预测具有 40%的敏感性和 80%的特异性。然而，在亚组分析中，该检测并未显示与 IA 发展有任何相关性。需要进一步开展更广泛的研究来验证最佳的 IA 风险预测策略。
