Invaziv Aspergillozis Tanısında Yardımcı Testlerin Değerlendirilmesi

Abstract

Invasive aspergillosis (IA) is an important cause of morbidity and mortality in immunosupressed patients. The gold standard test in diagnosis of IA is the appearance of invading hyphae in tissue biopsies and positive cultures. However, non-invasive diagnostic methods are needed since biopsy is not possible for each patient. There are various results in the literature about diagnostic accuracy of these methods. The purpose of this meta-analysis is to assess the diagnostic accuracy of whole blood, serum, bronchoalveolar lavage (BAL) fluid galactomannan (GM) and PCR (polymerase chain reaction) in hematologic cancer patients or hematopoietic stem cell transplant recipients. After literature search, 54 reports were included in the meta-analysis. Among patients with proven and probable IA; pooled sensitivity and specificity values for serum GM were %80 - %78, %74 - %96 and %70 - %96 for the cutoff values of 0.5, 1.0 and 1.5, respectively. Pooled sensitivity and specificity values for BAL GM were %78 - %86 and %76 - %94, for the cutoff values of 0.5 and 1.0, respectively. Pooled sensitivity and specificity values for whole blood/serum Aspergillus PCR were %72 - % 72 and %51 - %92, for single positive sample and two consecutive positive samples, respectively. Pooled sensitivity and specificity values for BAL Aspergillus PCR were %64 and %90. Cut off value 1.0 was considered optimal for both serum and BAL GM in this meta-analysis, although values above 0.5 were recommended to be positive by the manufacturer. Discriminative ability of serum GM and BAL GM assays in the diagnosis of IA are similar to each other. For consecutive whole blood/serum and BAL samples, discriminative ability of Aspergillus PCR assay in the diagnosis of IA is high. However, it would not be appropriate to use PCR assay for screening of IA, because of the low sensitivity. Aspergillus specific PCR can be used as a diagnostic criterion for probable IA after the standardization studies have been completed.