Early Diagnosis of Invasive Aspergillosis in Neutropenic Patients using Galactomannan Antigen Detection Test

Abstract

Background/Aim: Fungal infections pose significant problems for patients with hematological malignancies undergoing chemotherapy and/or bone marrow transplantation. Aspergillus fumigatus is a pathogenic filamentous fungus associated with several illnesses, including pulmonary aspergillosis and invasive aspergillosis. Reports reveal an increased incidence of Aspergillus infections in cancer patients. Consequently, prompt diagnosis is crucial to diminish morbidity and death, particularly in neutropenic individuals. The present study aim to measure the serial levels of Galactomannan in the serum of adult patients with hematological malignancies to detect early preclinical fungal infections and relate these findings with clinical and radiological outcomes, as well as prognosis. Patients and Methods: We assessed serial galactomannan levels via ELISA in blood samples from 59 adult patients with hematological malignancies undergoing therapy at Ain Shams University Hospital. Results: This investigation analyzed 59 hematologic patients. Notable findings revealed that neutropenia was present in 20.3% of cases, whereas fungal infections affected 23.7% of patients and shown a significant correlation with neutropenia (75% against 10.6% in non-neutropenic patients, p<0.001) and increased mortality rates (66.7% compared to 12.8%, p<0.001). Diagnostic methods, including the galactomannan assay and radiographic findings, demonstrated significant agreement (Kappa=0.75-0.95) in identifying fungal infections. The overall mortality rate was 23.7%,
primarily due to infections (57.1%), with neutropenic patients facing a 5.2-fold elevated mortality risk. Conclusions: These findings underscore the necessity for stringent antifungal prophylaxis and meticulous monitoring in neutropenic patients, particularly following bone marrow transplantation. Therefore, it is prudent to undertake routine screening for these individuals via the GM test to initiate
early antifungal therapy, even before the appearance of any clinical or radiological signs.