Clinical characteristics, radiologic findings, risk factors and outcomes of serum galactomannan-negative invasive pulmonary aspergillosis
Background: The sensitivity of galactomannan (GM) assay is suboptimal for detecting invasive pulmonary aspergillosis (IPA) in serum samples. However, the clinical characteristics, radiologic findings, and outcomes in patients with GM-negative IPA have not been fully elucidated. Methods: Over a 7-yea...
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| Format: | Article |
| Language: | English |
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Elsevier
2018-12-01
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| Series: | Journal of Microbiology, Immunology and Infection |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1684118217301020 |
| _version_ | 1811269647869149184 |
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| author | Jiwon Jung Mi Young Kim Yong Pil Chong Sang-Oh Lee Sang-Ho Choi Yang Soo Kim Jun Hee Woo Sung-Han Kim |
| author_facet | Jiwon Jung Mi Young Kim Yong Pil Chong Sang-Oh Lee Sang-Ho Choi Yang Soo Kim Jun Hee Woo Sung-Han Kim |
| author_sort | Jiwon Jung |
| collection | DOAJ |
| description | Background: The sensitivity of galactomannan (GM) assay is suboptimal for detecting invasive pulmonary aspergillosis (IPA) in serum samples. However, the clinical characteristics, radiologic findings, and outcomes in patients with GM-negative IPA have not been fully elucidated. Methods: Over a 7-year period, adult patients with proven or probable IPA by the EORTC/MSG definition were retrospectively enrolled. Patients with negative GM results and positive Aspergillus spp. cultures from sputum or bronchoalveolar lavage were classified into GM-negative IPA group. GM-positive and culture-negative IPA cases were selected at a 1:2 ratio. Results: Thirty-four patients with GM-negative IPA were compared to 68 randomly selected patients from 158 patients with GM-positive and culture-negative IPA. Patients with diabetes mellitus, chronic kidney disease, and steroid use were more common but those with hematologic malignancy, prior receipt of mold-active antifungal drugs, and neutropenia were less common in GM-negative IPA than in GM-positive IPA. Regarding radiologic findings, angioinvasive aspergillosis was less common in GM-negative IPA than in GM-positive IPA. The median number of days from diagnosis to appropriate antifungal therapy was higher in GM-negative IPA than in GM-positive IPA. Multivariate analysis indicated that neutropenia (adjusted odds ratio [aOR], 0.10) and prior receipt of mold-active antifungal drugs (aOR, 0.12) were inversely associated with GM-negative IPA. The 30-day and 90-day mortality were similar between the two groups. Conclusion: Neutropenia and prior receipt of mold-active antifungal drugs before GM assay were independently associated with GM positivity among patients with proven/probable IPA. Angioinvasive aspergillosis was less common in GM-negative IPA than in GM-positive IPA. Keywords: Galactomannan, Invasive pulmonary aspergillosis, Neutropenia |
| first_indexed | 2024-04-12T21:46:51Z |
| format | Article |
| id | doaj.art-be60a55c99a343568cad84fb0f85881a |
| institution | Directory Open Access Journal |
| issn | 1684-1182 |
| language | English |
| last_indexed | 2024-04-12T21:46:51Z |
| publishDate | 2018-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Microbiology, Immunology and Infection |
| spelling | doaj.art-be60a55c99a343568cad84fb0f85881a2022-12-22T03:15:37ZengElsevierJournal of Microbiology, Immunology and Infection1684-11822018-12-01516802809Clinical characteristics, radiologic findings, risk factors and outcomes of serum galactomannan-negative invasive pulmonary aspergillosisJiwon Jung0Mi Young Kim1Yong Pil Chong2Sang-Oh Lee3Sang-Ho Choi4Yang Soo Kim5Jun Hee Woo6Sung-Han Kim7Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea; Division of Infectious Diseases, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of KoreaDepartment of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea; Corresponding author. Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul 138-736, Republic of Korea. Fax: +82 2 3010 0090.Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of KoreaDepartment of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of KoreaDepartment of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of KoreaDepartment of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of KoreaDepartment of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of KoreaDepartment of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea; Corresponding author. Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 138-736, Republic of Korea. Fax: +82 2 3010 6970.Background: The sensitivity of galactomannan (GM) assay is suboptimal for detecting invasive pulmonary aspergillosis (IPA) in serum samples. However, the clinical characteristics, radiologic findings, and outcomes in patients with GM-negative IPA have not been fully elucidated. Methods: Over a 7-year period, adult patients with proven or probable IPA by the EORTC/MSG definition were retrospectively enrolled. Patients with negative GM results and positive Aspergillus spp. cultures from sputum or bronchoalveolar lavage were classified into GM-negative IPA group. GM-positive and culture-negative IPA cases were selected at a 1:2 ratio. Results: Thirty-four patients with GM-negative IPA were compared to 68 randomly selected patients from 158 patients with GM-positive and culture-negative IPA. Patients with diabetes mellitus, chronic kidney disease, and steroid use were more common but those with hematologic malignancy, prior receipt of mold-active antifungal drugs, and neutropenia were less common in GM-negative IPA than in GM-positive IPA. Regarding radiologic findings, angioinvasive aspergillosis was less common in GM-negative IPA than in GM-positive IPA. The median number of days from diagnosis to appropriate antifungal therapy was higher in GM-negative IPA than in GM-positive IPA. Multivariate analysis indicated that neutropenia (adjusted odds ratio [aOR], 0.10) and prior receipt of mold-active antifungal drugs (aOR, 0.12) were inversely associated with GM-negative IPA. The 30-day and 90-day mortality were similar between the two groups. Conclusion: Neutropenia and prior receipt of mold-active antifungal drugs before GM assay were independently associated with GM positivity among patients with proven/probable IPA. Angioinvasive aspergillosis was less common in GM-negative IPA than in GM-positive IPA. Keywords: Galactomannan, Invasive pulmonary aspergillosis, Neutropeniahttp://www.sciencedirect.com/science/article/pii/S1684118217301020 |
| spellingShingle | Jiwon Jung Mi Young Kim Yong Pil Chong Sang-Oh Lee Sang-Ho Choi Yang Soo Kim Jun Hee Woo Sung-Han Kim Clinical characteristics, radiologic findings, risk factors and outcomes of serum galactomannan-negative invasive pulmonary aspergillosis Journal of Microbiology, Immunology and Infection |
| title | Clinical characteristics, radiologic findings, risk factors and outcomes of serum galactomannan-negative invasive pulmonary aspergillosis |
| title_full | Clinical characteristics, radiologic findings, risk factors and outcomes of serum galactomannan-negative invasive pulmonary aspergillosis |
| title_fullStr | Clinical characteristics, radiologic findings, risk factors and outcomes of serum galactomannan-negative invasive pulmonary aspergillosis |
| title_full_unstemmed | Clinical characteristics, radiologic findings, risk factors and outcomes of serum galactomannan-negative invasive pulmonary aspergillosis |
| title_short | Clinical characteristics, radiologic findings, risk factors and outcomes of serum galactomannan-negative invasive pulmonary aspergillosis |
| title_sort | clinical characteristics radiologic findings risk factors and outcomes of serum galactomannan negative invasive pulmonary aspergillosis |
| url | http://www.sciencedirect.com/science/article/pii/S1684118217301020 |
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