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Braz J Infect Dis. 2017 Nov 21. pii: S1413-8670(17)30830-9. doi: 10.1016/j.bjid.2017.11.002. [Epub ahead of print]

Galactomannan use in clinical practice: providing free testing is not the answer.

Author information

1
Centro Universitário Ritter dos Reis (UniRitter), Porto Alegre, RS, Brazil.
2
Santa Casa de Misericórdia, Porto Alegre, RS, Brazil; Universidade Federal de Ciências da Saúde, Porto Alegre, RS, Brazil. Electronic address: pasqualotto@santacasa.tche.br.

Abstract

INTRODUCTION:

Invasive aspergillosis (IA) is a condition associated with a high mortality rate due to difficulties in performing an early diagnosis. In recent years, galactomannan (GM) detection has markedly improved the diagnosis of IA, but very little is known on how physicians deal with this test in clinical practice.

METHODS:

This cross-sectional study aimed to analyze the indications for the use of serum GM in a large Brazilian hospital, between 2015 and 2016. No specific protocol was in place for GM request. We reviewed the medical records of adult (>18 years-old) patients who were tested for GM due to one the following indications: screening, diagnosis, or treatment follow-up. Additional variables included demographic data, underlying diseases, presence of neutropenia, and use of previous antifungal (anti-Aspergillus) drugs.

RESULTS:

The mean age of the patients was 51 years-old (sd±15.8), and 63.3% of patients were male. Patients with hematological malignancies accounted for 60.1% of the cases, mostly acute myeloid leukemia (19.6%). GM testing was positive in 12.2% of patients, including 1.6% of occasions in which the test was used for screening purposes, 13.2% for diagnosis, and 32.4% during follow-up. Median time for chest imaging request was two days before GM testing. Previous antifungal therapy was reported for 35.1% of patients, mostly amphotericin B (57.1%).

CONCLUSION:

The correct use of GM testing is essential for an early diagnosis of IA, which may improve the prognosis of the disease. We demonstrated that clinicians usually ask for GM tests to confirm imaging findings, something that could be improved by medical education activities. We observed a low frequency of GM use for preemptive antifungal therapy (25.7%), which is worrying considering the well-known beneficial use of GM testing in this scenario.

KEYWORDS:

Aspergillosis; Aspergillus; Diagnosis; Immunosuppressed; Neutropenia; Opportunistic infections; Tomography

PMID:
29172032
DOI:
10.1016/j.bjid.2017.11.002
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