Low Sensitivity of the (1-3)-Beta-D-Glucan Assay for Diagnosis of Invasive Aspergillosis in Hematologic Malignancy Patients.

Abstract 2242

Poster Board II-219

Invasive aspergillosis (IA) is a common opportunistic infection in hematologic malignancy patients. The diagnosis of IA is difficult and the outcome is poor despite recent progress in treatment. The detection of galactomannan antigen is useful in diagnosis of IA and is defined as one of EORTC/MSG diagnostic criteria. The (1-3)-beta-D-glucan assay is also used in diagnosis of invasive fungal disease, but the sensitivity and specificity of these tests for IA are variable in recent reports. To evaluate the correlation of them, we analyzed retrospectively the results of these tests in IA cases of hematologic malignancy patients.

From January 2006 to December 2008, we reviewed 2914 hematologic malignancy patients (AML=492, ALL=198, MDS=284, NHL=1373, HL=92, MM=375) retrospectively who were recieved chemotherapy or stem cell transplantation(SCT). 607 cases received SCT are included in this study. We diagnosed IA according to the EORTC/MSG criteria, and extracted the data of galactomannan antigen and (1-3)-beta-D-glucan assay examined at diagnosis of each case.

43 cases(1.5%) are diagnosed as invasive fungal disease (Aspergillus=24, Candida=9, Mucor=6, Trichosporon=2, Cryptococcus=1, Geotrichum=1). 23 IA cases are analyzed (proven: 3 cases, probable: 20 cases). All cases are positive for galactomannan antigen test(range, 0.5-5.0< ODI, cut-off value:0.5), but only 9 cases for (1-3)-beta-D-glucan assay (range, 24.5-313pg/ml, cut-off value:20). In the three cases of proven IA, only one case are positive for this assay. There is no difference in patient characteristic and prognosis between the positive and negative group.

We conclude that the (1-3)-beta-D-glucan assay is not useful tool for diagnosis of invasive aspergillosis.