Two Non-invasive Diagnostic Tools for Invasive Aspergilosis: (1-3)-β-D-Glucan and the Galactomannan Assay

Amy Kelaher

doi:10.29074/ascls.19.4.222

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Amy Kelaher⇑
1. is a graduate student in the Department of Medical Research and Technology, University of Maryland School of Medicine, Baltimore MD

Address for correspondence: Amy Kelaher, Department of Medical and Research Technology, University of Maryland School of Medicine, 100 Penn Street-AHB Room #435, Baltimore MD 21201.(301) 496-3049, (410) 706-0073 (fax). akela001{at}umaryland.edu.

Extract

Invasive aspergillosis (IA) is a serious cause of morbidity and mortality among immunocompromised patients. Prompt and non-invasive methods for diagnosing IA are needed to improve the management of this life-threatening infection in patients with hematological disorders. In summary, this retrospective review of studies performed on the two assays finds that both assays have high sensitivity and specificity but are more useful when used together as a diagnostic strategy for patients with invasive aspergillosis.

Invasive aspergillosis (IA) is one of the most serious causes of morbidity and mortality among immunocompromised patients. Among several factors that contribute to the high mortality rate, difficulties in establishing a reliable diagnosis early enough for successful intervention have been reported.¹ The crude mortality rate of IA is very high despite appropriate antifungal treatment, since the difficulty in obtaining an early diagnosis results in a delay in establishing treatment. The diagnosis of IA is frequently established postmortem. The establishment of a prompt and optimal noninvasive method for diagnosing IA is needed to improve the management of this life-threatening infection in patients with hematological disorders.^2,3

Current conventional diagnostic methods such as histological examination and cultures of deep tissues are not only insensitive, but require an aggressive approach. This often precludes their use due to profound thrombocytopenia, hypoxemia, and the critical condition of these patients. As a result, many physicians begin empiric or prophylactic amphotericin B therapy before making a definitive diagnosis. Initiation of empiric or prophylactic therapy with amphotericin B may lead to treatment failure of a full…

ABBREVIATIONS: BDG = beta-D-glucan; GM = galactomannan; IA = invasive aspergillosis; IFI = invasive fungal infections; ODI= optical density index.