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Int J Hematol (2009) 90:463470 DOI 10.1007/s12185-009-0429-8
ORIGINAL ARTICLE
Detection of sputum Aspergillus galactomannan for diagnosis of invasive pulmonary aspergillosis in haematological patients
Shun-ichi Kimura Jun Odawara
Takatoshi Aoki Masayuki Yamakura
Masami Takeuchi Kosei Matsue
Received: 16 July 2009 / Revised: 9 September 2009 / Accepted: 10 September 2009 / Published online: 20 October 2009 The Japanese Society of Hematology 2009
Abstract We investigated the diagnostic utility of Aspergillus galactomannan (GM) in sputum for diagnosis of invasive pulmonary aspergillosis (IPA) in haematologic patients and compared the results with those of bronchial lavage uid (BLF) and serum. Patients were classied into 4 groups using modied European Organization for Research and Treatment of Cancer criteria: group A, proven IPA; group B, probable IPA; group C, possible IPA; group D, others. Groups A and B were considered the IPA group (n = 6); group D was considered non-IPA group (n = 37); group C (n = 13) was equivocal for IPA. As a true negative control, sputa from patients with community-acquired pneumonia (CAP) without risk factors (group E, n = 22) were used. From the receiver-operating characteristic curves, the cut-off levels were determined as 1.2 in sputum, 0.51.3 in BLF and 0.5 in serum. The sensitivity and specicity of sputum, BLF and serum GM were 100 and 62.2%, 66.7 and 100%, and 83.3 and 81.1%, respectively. Twenty-two patients with CAP (group E) showed median GM levels in the sputa of 0.1 (range 0.01.0). Sputum GM is a useful non-invasive test for screening of IPA in haematological patients, and may also be useful for assessment of the risk of developing IPA.
Keywords Galactomannan Sputum BLF Serum
Aspergillosis
1 Introduction
Invasive pulmonary aspergillosis (IPA) is one of the major causes of morbidity and mortality in patients with haematological diseases receiving intensive chemotherapy, corticosteroid and stem cell transplantation. An accurate and early diagnosis of IPA is important for the immediate commencement of treatment, which is associated with improved survival [1]. However, this is frequently challenging because the symptoms and signs of IPA are usually non-specic and culture of Aspergillus is rarely successful. Measurement of serum Aspergillus galactomannan (GM) has been reported to be useful for diagnosis of IPA in immunocompromised patients, such as those with neutropoenia and stem cell transplant recipients...