Evaluation of galactomannan assay in diagnosing invasive aspergillosis
,
Abstract
Background and Objectives: In most laboratories, diagnosis of invasive aspergillosis (IA) depends on culture and histopathological examination of the involved tissues. Galactomannan (GM) is a polysaccharide antigen detectable in body fluids and represents an ideal assay for diagnosing invasive pulmonary aspergillosis. The main objectives of this study were to estimate the proportion of patients with proven, probable, and possible aspergillosis and to compare different diagnostic methods.
Materials and Methods: Samples for culture, microscopy, and GM assay were taken from a total of 60 patients. The enrolled patients were divided into proven, probable, and possible aspergillosis groups.
Results: Among the 60 patients in the study, there were 9 (15%) cases of probable aspergillosis. galactomannan assay was positive in 19 patients. Galactomannan assay had a higher sensitivity (66.7%) when compared to other fungal assays for diagnosing probable aspergillosis.
Conclusion: Diagnosing invasive aspergillosis is extremely challenging, and biomarkers such as galactomannan assay are important for early diagnosis. Raising the cutoff to >1 can eliminate false-positive results associated with the GM assay.
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10. Donhuijsen K, Petersen P, Schmid WK. Trend reversal in the frequency of mycoses in hematological neoplasias: autopsy results from 1976 to 2005. Dtsch Arztebl Int 2008; 105: 501-506.
11. Hammond SP, Marty FM, Bryar JM, DeAngelo DJ, Baden LR. Invasive fungal disease in patients treated for newly diagnosed acute leukemia. Am J Hematol 2010; 85: 695-699.
12. Pagano L, Caira M, Candoni A, Offidani M, Fianchi L, Martino B, et al. The epidemiology of fungal infections in patients with hematologic malignancies: the SEIFEM-2004 study. Haematologica 2006; 91: 1068-1075.
13. Nivoix Y, Velten M, Letscher-Bru V, Moghaddam A, Natarajan-Amé S, Fohrer C, et al. Factors associated with overall and attributable mortality in invasive aspergillosis. Clin Infect Dis 2008; 47: 1176-1184.
14. Pagano L, Caira M, Nosari A, Van Lint MT, Candoni A, Offidani M, et al. Fungal infections in recipients of hematopoietic stem cell transplants: results of the SEIFEM B-2004 study--Sorveglianza Epidemiologica Infezioni Fungine Nelle Emopatie Maligne. Clin Infect Dis 2007; 45: 1161-1170.
15. Dagenais TR, Keller NP. Pathogenesis of Aspergillus fumigatus in invasive aspergillosis. Clin Microbiol Rev 2009; 22: 447‑465.
16. Maschmeyer G, Haas A, Cornely OA. Invasive aspergillosis: Epidemiology, diagnosis and management in immunocompromised patients. Drugs 2007; 67: 1567‑1601.
17. Baddley JW. Clinical risk factors for invasive aspergillosis. Med Mycol 2011; 49 (Suppl 1): S7‑S12.
18. Grow WB, Moreb JS, Roque D, Manion K, Leather H, Reddy V, et al. Late onset of invasive aspergillus infection in bone marrow transplant patients at a university hospital. Bone Marrow Transplant 2002; 29: 15‑19.
19. Penack O, Rempf P, Graf B, Blau IW, Thiel E. Aspergillus galactomannan testing in patients with long‑term neutropenia: Implications for clinical management. Ann Oncol 2008; 19: 984‑989.
20. Thornton CR. Detection of invasive aspergillosis. Adv Appl Microbiol 2010; 70:187‑216.
21. Maertens J, Van Eldere J, Verhaegen J, Verbeken E, Verschakelen J, Boogaerts M. Use of circulating galactomannan screening for early diagnosis of invasive aspergillosis in allogeneic stem cell transplant recipients. J Infect Dis 2002; 186: 1297‑1306.
22. Leeflang MM, Debets‑Ossenkopp YJ, Visser CE, Scholten RJ, Hooft L, Bijlmer HA, et al. Galactomannan detection for invasive aspergillosis in immunocompromised patients. Cochrane Database Syst Rev 2008; 4: CD007394.
23. Donnelly JP, Chen SC, Kauffman CA, Steinbach WJ, Baddley JW, Verweij PE, et al. Revision and Update of the Consensus Definitions of Invasive Fungal Disease From the European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium. Clin Infect Dis 2020; 71: 1367-1376.
24. Malhotra S, Kumari R, Chauhan AK, Bhatia NK, Kaur A, Sharma B, et al. Diagnostic value of galactomannan antigen test in serum and bronchoalveolar lavage fluid sample from suspected patients of invasive pulmonary aspergillosis. Indian J Pathol Microbiol 2021; 64: 732-734.
25. Sun KS, Tsai CF, Chii S, Huang WC. Clinical outcome and prognostic factors associated with invasive pulmonary aspergillosis: An 11‐year follow‐up report from Taiwan. PLoS One 2017; 12(10): e0186422.
26. Mercier T, Schauwvlieghe A, de Kort E, Dunbar A, Reynders M, Guldentops E, et al. Diagnosing invasive pulmonary aspergillosis in hematology patients: A retrospective multicenter evaluation of a novel lateral flow device. J Clin Microbiol 2019; 57(4): e01913‐18.
27. Sarrafzadeh SA, Hoseinpoor Rafati A, Ardalan M, Mansouri D, Tabarsi P, Pourpak Z. The accuracy of serum galactomannan assay in diagnosing invasive pulmonary aspergillosis. Iran J Allergy Asthma Immunol 2010; 9: 149-155.
28. Mohindra R, Capoor MR, Puri S, Raheja H, Gupta DK, Gupta B, et al. Evaluation of serum galactomannan enzyme immunoassay at two different cut-offs for the diagnosis of invasive aspergillosis in patients with febrile neutropenia. Indian J Med Microbiol 2017; 35: 237-242.
29. Ghosh I, Raina V, Kumar L, Sharma A, Bakhshi S, Iqbal S. Serum galactomannan assay for diagnosis of probable invasive Aspergillosis in acute leukemia and hematopoietic stem cell transplantation. Indian J Med Paediatr Oncol 2013; 34: 74-79.
30. Boonsarngsuk V, Niyompattama A, Teosirimongkol C, Sriwanichrak K. False-positive serum and bronchoalveolar lavage Aspergillus galactomannan assays caused by different antibiotics. Scand J Infect Dis 2010; 42: 461-468.
2. Meersseman W, Vandecasteele SJ, Wilmer A, Verbeken E, Peetermans WE, Van Wijngaerden E. Invasive aspergillosis in critically ill patients without malignancy. Am J Respir Crit Care Med 2004; 170: 621-625.
3. Schwartz S, Ruhnke M, Ribaud P, Corey L, Driscoll T, Cornely OA, Schuler U, et al. Improved outcome in central nervous system aspergillosis, using voriconazole treatment. Blood 2005; 106: 2641-2645.
4. Hope WW, Walsh TJ, Denning DW. Laboratory diagnosis of invasive aspergillosis. Lancet Infect Dis 2005; 5: 609-622.
5. Grau S, Solano C, Garcia-Vidal C, Jarque I, Barrueta J, Peral C, et al. Pharmacoeconomic Analysis of The Use of Voriconazole, Posaconazole And Micafungin In The Primary Prophylaxis of Invasive Fungal Infections In Recipients of Allogeneic Hematopoietic Stem Cell Transplants In Spain. Value Health 2015; 18(7): A581.
6. Burghi G, Lemiale V, Azoulay E. Invasive aspergillosis in critically ill hematology patients: outcomes and prognostic factors associated with mortality. Crit Care 2011; 15(Suppl 1): P242.
7. Nihtinen A, Anttila VJ, Richardson M, Ruutu T, Juvonen E, Meri T, et al. Invasive Aspergillus infections in allo-SCT recipients: environmental sampling, nasal and oral colonization and galactomannan testing. Bone Marrow Transplant 2010; 45: 333-338.
8. Pagano L, Stamouli M, Tumbarello M, Verga L, Candoni A, Cattaneo C, et al. Risk of invasive fungal infection in patients affected by acute promyelocytic leukaemia. A report by the SEIFEM-D registry. Br J Haematol 2015; 170: 434-439.
9. Chamilos G, Luna M, Lewis RE, Bodey GP, Chemaly R, Tarrand JJ, et al. Invasive fungal infections in patients with hematologic malignancies in a tertiary care cancer center: an autopsy study over a 15-year period (1989-2003). Haematologica 2006; 91: 986-989.
10. Donhuijsen K, Petersen P, Schmid WK. Trend reversal in the frequency of mycoses in hematological neoplasias: autopsy results from 1976 to 2005. Dtsch Arztebl Int 2008; 105: 501-506.
11. Hammond SP, Marty FM, Bryar JM, DeAngelo DJ, Baden LR. Invasive fungal disease in patients treated for newly diagnosed acute leukemia. Am J Hematol 2010; 85: 695-699.
12. Pagano L, Caira M, Candoni A, Offidani M, Fianchi L, Martino B, et al. The epidemiology of fungal infections in patients with hematologic malignancies: the SEIFEM-2004 study. Haematologica 2006; 91: 1068-1075.
13. Nivoix Y, Velten M, Letscher-Bru V, Moghaddam A, Natarajan-Amé S, Fohrer C, et al. Factors associated with overall and attributable mortality in invasive aspergillosis. Clin Infect Dis 2008; 47: 1176-1184.
14. Pagano L, Caira M, Nosari A, Van Lint MT, Candoni A, Offidani M, et al. Fungal infections in recipients of hematopoietic stem cell transplants: results of the SEIFEM B-2004 study--Sorveglianza Epidemiologica Infezioni Fungine Nelle Emopatie Maligne. Clin Infect Dis 2007; 45: 1161-1170.
15. Dagenais TR, Keller NP. Pathogenesis of Aspergillus fumigatus in invasive aspergillosis. Clin Microbiol Rev 2009; 22: 447‑465.
16. Maschmeyer G, Haas A, Cornely OA. Invasive aspergillosis: Epidemiology, diagnosis and management in immunocompromised patients. Drugs 2007; 67: 1567‑1601.
17. Baddley JW. Clinical risk factors for invasive aspergillosis. Med Mycol 2011; 49 (Suppl 1): S7‑S12.
18. Grow WB, Moreb JS, Roque D, Manion K, Leather H, Reddy V, et al. Late onset of invasive aspergillus infection in bone marrow transplant patients at a university hospital. Bone Marrow Transplant 2002; 29: 15‑19.
19. Penack O, Rempf P, Graf B, Blau IW, Thiel E. Aspergillus galactomannan testing in patients with long‑term neutropenia: Implications for clinical management. Ann Oncol 2008; 19: 984‑989.
20. Thornton CR. Detection of invasive aspergillosis. Adv Appl Microbiol 2010; 70:187‑216.
21. Maertens J, Van Eldere J, Verhaegen J, Verbeken E, Verschakelen J, Boogaerts M. Use of circulating galactomannan screening for early diagnosis of invasive aspergillosis in allogeneic stem cell transplant recipients. J Infect Dis 2002; 186: 1297‑1306.
22. Leeflang MM, Debets‑Ossenkopp YJ, Visser CE, Scholten RJ, Hooft L, Bijlmer HA, et al. Galactomannan detection for invasive aspergillosis in immunocompromised patients. Cochrane Database Syst Rev 2008; 4: CD007394.
23. Donnelly JP, Chen SC, Kauffman CA, Steinbach WJ, Baddley JW, Verweij PE, et al. Revision and Update of the Consensus Definitions of Invasive Fungal Disease From the European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium. Clin Infect Dis 2020; 71: 1367-1376.
24. Malhotra S, Kumari R, Chauhan AK, Bhatia NK, Kaur A, Sharma B, et al. Diagnostic value of galactomannan antigen test in serum and bronchoalveolar lavage fluid sample from suspected patients of invasive pulmonary aspergillosis. Indian J Pathol Microbiol 2021; 64: 732-734.
25. Sun KS, Tsai CF, Chii S, Huang WC. Clinical outcome and prognostic factors associated with invasive pulmonary aspergillosis: An 11‐year follow‐up report from Taiwan. PLoS One 2017; 12(10): e0186422.
26. Mercier T, Schauwvlieghe A, de Kort E, Dunbar A, Reynders M, Guldentops E, et al. Diagnosing invasive pulmonary aspergillosis in hematology patients: A retrospective multicenter evaluation of a novel lateral flow device. J Clin Microbiol 2019; 57(4): e01913‐18.
27. Sarrafzadeh SA, Hoseinpoor Rafati A, Ardalan M, Mansouri D, Tabarsi P, Pourpak Z. The accuracy of serum galactomannan assay in diagnosing invasive pulmonary aspergillosis. Iran J Allergy Asthma Immunol 2010; 9: 149-155.
28. Mohindra R, Capoor MR, Puri S, Raheja H, Gupta DK, Gupta B, et al. Evaluation of serum galactomannan enzyme immunoassay at two different cut-offs for the diagnosis of invasive aspergillosis in patients with febrile neutropenia. Indian J Med Microbiol 2017; 35: 237-242.
29. Ghosh I, Raina V, Kumar L, Sharma A, Bakhshi S, Iqbal S. Serum galactomannan assay for diagnosis of probable invasive Aspergillosis in acute leukemia and hematopoietic stem cell transplantation. Indian J Med Paediatr Oncol 2013; 34: 74-79.
30. Boonsarngsuk V, Niyompattama A, Teosirimongkol C, Sriwanichrak K. False-positive serum and bronchoalveolar lavage Aspergillus galactomannan assays caused by different antibiotics. Scand J Infect Dis 2010; 42: 461-468.
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| Issue | Vol 18 No 4 (2026) | |
| Section | Original Article(s) | |
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| Galactomannan Aspergillus Assay Culture Microscopy | ||
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How to Cite
1.
Sachu A, David A. Evaluation of galactomannan assay in diagnosing invasive aspergillosis. Iran J Microbiol. 2026;18(4):615-620.
