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001-es BibID:	BIBFORM059207
Első szerző:	Paholcsek Melinda (molekuláris biológus, genetikus)
Cím:	Combining standard clinical methods with PCR showed improved diagnosis of invasive pulmonary aspergillosis in patients with hematological malignancies and prolonged neutropenia / Melinda Paholcsek, Gabor Fidler, Jozsef Konya, Laszlo Rejto, Gabor Mehes, Evelin Bukta, Juergen Loeffler, Sandor Biro
Dátum:	2015
ISSN:	1471-2334
Megjegyzések:	Background: We assessed the diagnostic value of standard clinical methods and combined biomarker testing(galactomannan assay and polymerase chain reaction screening) in a prospective case?control study to detectinvasive pulmonary aspergillosis in patients with hematological malignancies and prolonged neutropenia.Methods: In this observational study 162 biomarker analyses were performed on samples from 27 febrile neutropenicepisodes. Sera were successively screened for galactomannan antigen and for Aspergillus fumigatus specific nucleic acidtargets. Furthermore thoracic computed tomography scanning was performed along with bronchoscopy with lavagewhen clinically indicated. Patients were retrospectively stratified to define a case-group with "proven" or "probable"invasive pulmonary aspergillosis (25.93 %) and a control-group of patients with no evidence for of invasive pulmonaryaspergillosis (74.07 %). In 44.44 % of episodes fever ceased in response to antibiotic treatment (group II). Empiricalantifungal therapy was administered for episodes with persistent or relapsing fever (group I). 48.15 % of patientsdied during the study period. Postmortem histology was pursued in 53.85 % of fatalities.Results: Concordant negative galactomannan and computed tomography supported by a polymerase chainreaction assay were shown to have the highest discriminatory power to exclude invasive pulmonary aspergillosis.Bronchoalveolar lavage was performed in 6 cases of invasive pulmonary aspergillosis and in 15 controls. Althoughbronchoalveolar lavage proved negative in 93 % of controls it did not detect IPA in 86 % of the cases. Remarkablypost mortem histology convincingly supported the presence of Aspergillus hyphae in lung tissue from a single casewhich had consecutive positive polymerase chain reaction assay results but was misdiagnosed by both computedtomography and consistently negative galactomannan assay results. For the galactomannan enzyme-immunoassay thediagnostic odds ratio was 15.33 and for the polymerase chain reaction assay it was 28.67. According to Cohen's kappaour in-house polymerase chain reaction method showed a fair agreement with the galactomannan immunoassay.Combined analysis of the results from the Aspergillus galactomannan enzyme immunoassay together with thosegenerated by our polymerase chain reaction assay led to no misdiagnoses in the control group.Conclusion: The data from this pilot-study demonstrate that the consideration of standard clinical methods combinedwith biomarker testing improves the capacity to make early and more accurate diagnostic decisions.
Tárgyszavak:	Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban Invasive pulmonary aspergillosis Biomarkers Combination testing Acute leukemia Neutropenic fever
Megjelenés:	BMC Infectious Diseases. - 15 : 1 (2015), p. 251. -
További szerzők:	Fidler Gábor (1987-) (molekuláris biológus, genetikus) Kónya József (1964-) (szakorvos, klinikai mikrobiológus) Rejtő László (1963-) (belgyógyász, haematológus) Méhes Gábor (1966-) (patológus) Bukta Evelin Loeffler, Juergen Biró Sándor (1949-) (molekuláris genetikus)
Pályázati támogatás:	SROP-4.2.2.B-15/1/KONV-2015-0001 Egyéb TÁMOP-4.2.4.A/ 2-11/1-2012-0001 TÁMOP
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