Fungal biomarker monitoring and CT scans for early detection of invasive fungal disease in neutropenic hematological patients. Issue 1 (January 2022)

• Record Type: Journal Article
• Authors: Kimura, Shun-ichi; Kanda, Yoshinobu; Oyake, Tatsuo; Yamaguchi, Hiroki; Fujiwara, Shin-ichiro; Okamoto, Akinao; Fujita, Hiroyuki; Saburi, Yoshio; Tamura, Kazuo
• Is Part Of: Journal of infection. Volume 84:Issue 1(2022)
• Page Start: 80
• Page End: 86
• Publication Date: 2022-01
• Subjects: Invasive fungal disease -- Aspergillus galactomannan -- (1→3)-β-D-glucan -- Computed tomography -- Positive predictive value; Infection -- Periodicals; Bacterial Infections -- Periodicals; Communicable Diseases -- Periodicals; Electronic journals; 616.905
• DOI: 10.1016/j.jinf.2021.10.018
• Languages: English
• ISSNs: 0163-4453

Abstract

Highlights: A post-hoc analysis of a prospective randomized controlled trial ( n = 413) was performed. Afebrile screening of fungal biomarkers in low-risk treatment is not useful. Fungal biomarker monitoring is useful in high-risk treatment. Chest CT scans in cases of persistent fever, recurrent fever and positive biomarkers are essential. Chest CT should be reevaluated in persistent fever lasting for 7 days or longer. Summary: Objectives: By using data from the CEDMIC trial ( n = 413), we conducted a post-hoc analysis of the diagnostic value of biomarker monitoring and chest computed tomography (CT) scans for the early detection of invasive fungal disease (IFD) in neutropenic hematological patients. Methods: IFDs were defined in accordance with the EORTC/MSG definition with some modifications. Biomarkers such as Aspergillus galactomannan (GM) and (1→3)-β-D-glucan (βDG) were measured weekly. Results: The positive predictive value (PPV) of GM and βDG in cases of high-risk treatment were 0.70 and 0.69, while those in low-risk treatment were 0.08 and 0, respectively. All of the positive biomarkers that were measured before the development of fever in low-risk treatment were false positives. The proportion of patients who had abnormal chest CT findings was 19% in persistent fever at 4–6 days, 57% at 7 days or later and 36% in recurrent fever. Sixty-nine percent of the patients who had abnormal findings at 7 days or later did not have abnormalities at 4–6 days. Conclusions: Afebrile screening of biomarkers in low-risk treatment is not useful. Chest CT should be reevaluated in persistent fever lasting for 7 days or longer even in patients who did not have abnormalities within 6 days.