immunology of infectious and parasitic diseases - XXXVII Congress ...

GALACTOMANNAN ANTIGENEMIA SCREENING IN NEUTROPENIC
PATIENTS WITH HEMATOLOGICAL DISEASES IN BAHIA STATE, BRAZIL
KELLY CRISTINE MOURA COSTA PEDROZA (1); SÓCRATES BEZERRA DE
MATOS (1); MÔNICA BOTURA (2); MARCO AURÉLIO SALVINO (2); TIAGO
THALES (3); ROBERTO JOSÉ MEYER (4); FERNANDA W. DE M. LIMA (1)
(1) Serviço de Imunologia de Doenças Infecciosas - SIDI / Universidade
Federal da Bahia; (2) Centro de Transplante de Medula Óssea - CTMO /
Hospital Universitário Prof. Edgard Santos; (3) Instituto de Ciências da Saúde /
UFBA
Introduction: Invasive aspergillosis (IA) is a major cause of morbidity in
immunossuppressed patients, in particular those with cancer or hematological
diseases and bone marrow ⁄ hematopoietic stem cell transplant recipients (BMT
⁄ HSCT). Detection of IA represents a diagnostic challenge and relies on
Detection of IA represents a diagnostic challenge and relies on
a combination of clinical, microbiology and histopathology datas. An important
feature in the pathogenesis of Aspergillus is angioinvasion, a trait that provides
opportunities to develop tests that detect characteristic antigenic signatures
molecules in biological fluids, as galactomannan (GM), a heat-steable
heteropolysaccharide. Serum GM determination is included as microbiological
criteria in the diagnosis of IA in consensus by the European Organization for
Research and Treatment of Cancer and the National Institute of Allergy and
Infectious Diseases Mycology Study Group (EORTC/MSG). The aim of this
work is to evaluate the implantation of GM serial screening in neutropenic
patients with hematological disease in a university hospital, in Bahia state,
Brazil.
Methods and Results: This study was conducted between April 2011 and July
2012. Patients admitted to the Hematology Center of university hospital were
eligible if they had absolute neutrophil count < 500 cells/mm 3 . Serum samples
were obtained twice weekly and GM antigen was detected by direct doublesandwich
ELISA (Platelia Aspergillus; Bio-Rad, France). A result was
considered positive only when two consecutive GM assays presented O.D.
index ≥ 0.5. The study was approved by hospital‟s Ethic Committe. A total of 99
neutropenic episodes (63 patients – 17 to 74 years old, 31 men and 32 women)
were investigated. Antifungal prophylaxis was done in 34 episodes, which not
positive GM results were obtained. In the group without antifungal prophylaxis
was characterized a probable IA case, with serum GM positive. Patient with
multiple myeloma, autologous BMT, neutropenic for 9 days. The serum GM
index declined after preemptive therapy.
Conclusion: This Hematology Center is the first in Bahia state to use the
serum GM detection as tool to IA diagnostic. Preemptive therapy based on GM-