Invasive mould disease (IMD) accounts for one-half to two-thirds of all systemic mycoses in immunocompromised patients and is most frequently caused by Aspergillus species. Over the past two decades, the number of patients at risk has expanded due to the wider use of intensive myelosuppressive and /or immunosuppressive agents in the treatment of hematological cancers, in particular in those with acute myeloid leukemia and myelodysplastic syndromes (Maertens et al., 2011).
Galactomannan (GM) is a heteropolysaccharide composed of a non immunogenic mannan core and immuno-reactive galactofuransyl side chains in the cell walls of most Aspergillus and Penicillium species. A double-sandwich enzyme-linked immunosorbent assay for determination of Aspergillus GM was recently approved by the U.S. Food and Drug Administration (FDA) to facilitate early diagnosis of invasive aspergillosis. It is out of doubt the value of screening prospectively for circulating Aspergillus GM in adult hematological cancer patients.
This marker provides an early diagnosis of IA and the implementation of pre-emptive therapeutic strategies (Yu-Tsung et al., 2007).
Aim of the Work:
The aim of this study was early detection of Invasive Fungal Infections (IFI) in patients with Acute Myeloid Leukemia (AML) and Acute Lymphoid Leukemia (ALL) admitted to the National Cancer Institute(NCI),Cairo University by Galactomannan test ,and to study whether they catch this infection from the hospital or not.
Patients and Methods:
This study was conducted on 80 patients who were allocated from the medical oncology department of the National Cancer Institute, Cairo University. The study was classified into 2 parts: Part I is a prospective study during the period from 2009 to 2011 and part II is a retrospective study from 2007 to the end of 2008.
All the patients were newly diagnosed as AML or ALL. The patients were in the induction phase of chemotherapy.
In part I of the study: 40 Patients were prospectively screened for Galactomannan test, on the first day of admission then once again on the third week during the whole induction period of treatment, for early diagnosis of IFI in those patients.
GM levels were determined using the Platelia Aspergillus enzyme immunoassay by following the manufacturer’s instructions.
In part II of the study: 40 Patients were retrospectively studied to assess the profile of IFI among those patients.
All patients have positive results of blood culture for candida species or Aspergillus species as a mycological evidence of IFI.
RESULTS:
• IFI was classified into 2 categories:
1. Probable IFI in 27.5% and 52.5% in part I and part II, respectively.
2. Possible IFI in 72.5% and 47.5% in part I and part II, respectively.
• The frequency of positive GM test as a screening test in the 1st day of admission was 40%.
• The sensitivity and specificity of GM test was 63.3% and 68.9%, respectively.
• False positive GM test was considered 17.2%.
• False negative GM test was considered 36.3%.
• 100% of patients who did not receive any antifungal therapy were died in part I of the study.
• Zero% and 13.6% of patients who received itraconazole were died in part I and part II, respectively.
• 27.7% of patients who received fluconazole were died in part I and part II.
• Survival rate was 100% and 86.4% in patients who started on itraconazole in part I and in part II, respectively.
• Survival rate was 72.3% in patients who started on fluconazole in part I in part II.
• The frequency of acquiring IFI during hospitalization in this study was considered to be 7.5%.
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