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Published on: March 22, 2012
False-positive Aspergillus galactomannan antigenaemia after haematopoietic stem cell transplantation
Yuki Asano-Mori1, Yoshinobu Kanda, Kumi Oshima
1Department of Hematology and Oncology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
Objectives:
Although Aspergillus galactomannan (GM) antigen detection is widely applied in the diagnosis of invasive aspergillosis (IA), false-positive reactions with fungus-derived antibiotics, other fungal genera or the passage of dietary GM through injured mucosa are a matter of concern. The aim of this study was to investigate the cumulative incidence and risk factors for false-positive GM antigenaemia.
Patients And Methods:
The records of 157 adult allogeneic haematopoietic stem cell transplantation (HSCT) recipients were retrospectively analysed. Episodes of positive GM antigenaemia, defined as two consecutive GM results with an optical density index above 0.6, were classified into true, false and inconclusive GM antigenaemia by reviewing the clinical course.
Results:
Twenty-five patients developed proven or probable IA with a 1 year cumulative incidence of 12.9%, whereas 50 experienced positive GM antigenaemia with an incidence of 32.2%. Among the total 58 positive episodes of the 50 patients, 29 were considered false-positive. The positive predictive value (PPV) was lower during the first 100 days than beyond 100 days after HSCT (37.5% versus 58.8%). Gastrointestinal chronic graft-versus-host disease (GVHD) was identified as the only independent significant factor for the increased incidence of false-positive GM antigenaemia (PPV 0% versus 66.7%, P = 0.02).
Conclusions:
GM antigen results must be considered cautiously in conjunction with other diagnostic procedures including computed tomography scans, especially during the first 100 days after HSCT and in patients with gastrointestinal chronic GVHD.
Insights
False-positive Aspergillus galactomannan (GM) results are common in hematopoietic stem cell transplant (HSCT) patients. Gastrointestinal chronic graft-versus-host disease (GVHD) significantly increases false-positive GM antigenaemia risk.
Area of Science:
- Medical Mycology
- Transplantation Immunology
- Clinical Diagnostics
Background:
- Aspergillus galactomannan (GM) antigen detection aids in diagnosing invasive aspergillosis (IA).
- Concerns exist regarding false-positive GM results due to various factors, including antibiotics and dietary intake.
- Identifying risk factors for false-positive GM antigenaemia is crucial for accurate IA diagnosis in immunocompromised patients.
Purpose of the Study:
- To determine the cumulative incidence of false-positive GM antigenaemia in allogeneic hematopoietic stem cell transplantation (HSCT) recipients.
- To identify independent risk factors associated with false-positive GM results.
Main Methods:
- Retrospective analysis of 157 adult allogeneic HSCT recipients.
- Classification of positive GM antigenaemia episodes (optical density index > 0.6) as true, false, or inconclusive based on clinical review.
- Statistical analysis to identify significant risk factors.
Main Results:
- Fifty patients experienced positive GM antigenaemia (32.2% incidence), with 29 episodes (50%) classified as false-positive.
- The positive predictive value (PPV) for GM antigenaemia was lower within 100 days post-HSCT (37.5%) compared to later periods (58.8%).
- Gastrointestinal chronic graft-versus-host disease (GVHD) was the sole independent factor significantly increasing the incidence of false-positive GM antigenaemia (PPV 0% vs. 66.7%, P=0.02).
Conclusions:
- GM antigen results require cautious interpretation alongside other diagnostic tools like CT scans.
- Particular vigilance is needed in the early post-HSCT period (first 100 days).
- Patients with gastrointestinal chronic GVHD represent a high-risk group for false-positive GM antigenaemia, necessitating careful consideration of test results.
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