galactomannan and Cross-Infection

Invasive aspergillosis, chronic pulmonary aspergillosis and allergic bronchopulmonary aspergillosis are the clinical forms of aspergillosis. Although there is a great number of Aspergillus species, Aspergillus fumigatus-complex is the more frequent aetiological agent, regardless of clinical form or baseline condition. The increase in immunosuppressive agents and the higher use of corticosteroids in chronic obstructive pulmonary disease have led to aspergillosis becoming more prominent in recent years. Galactomannan detection and radiological diagnostic images complement the limitations of microbiology cultures in these patients. Voriconazole and liposomal amphotericin B are the gold standard in patients requiring therapy, and posaconazole, itraconazole, caspofungin and other echinocandins are effective alternatives. The prognosis depends of clinical forms and characteristics of the host, but it is particularly poor in the disseminated invasive forms.

Topics: Antifungal Agents; Aspergillosis; Aspergillus; Cross Infection; Drug Resistance, Multiple, Fungal; Endocarditis; Endophthalmitis; Fungemia; Galactose; Humans; Immunocompromised Host; Mannans; Neuroaspergillosis; Postoperative Complications; Pulmonary Aspergillosis; Radiography; Risk Factors; Salvage Therapy; Species Specificity; Vulnerable Populations

Topics: Antifungal Agents; Aspergillosis; Aspergillus fumigatus; Biomarkers; Cross Infection; Fatal Outcome; Galactose; Haemophilus influenzae; Hepatitis C, Chronic; Humans; Immunocompromised Host; Liver Cirrhosis; Low Back Pain; Lumbar Vertebrae; Male; Mannans; Middle Aged; Multiple Organ Failure; Opportunistic Infections; Pulmonary Disease, Chronic Obstructive; Pyrimidines; Spondylitis; Triazoles; Voriconazole

Invasive aspergillosis (IA) is a serious opportunistic infection in immunocompromised patients. Transplant recipients and patients with cancer represent the highest risk group. The antifungal treatment involves prolonged hospitalization and high economic resources.. to estimate costs represented by IA as an intercurrent complication of oncologic treatment.. Retrospective case-control study. Estimation of the cost of treatment in pediatric oncologic patients with IA in the Hospital Luis Calvo Mackenna during the years 2007-2008 was done. A control for each case of IA paired by sex, age, number of diagnosis and clinical department was selected.. There were 13 patients during the observation period. The attributable cost of treatment of aspergillosis was US $23,600 and the cost for each indicator was: hospital days US $16,500; antifungal therapy US $7,000; and serum galactomannan US $100.. In this study, the cost of treating IA is mainly due to hospitalization and antifungal medications. Three patients acquired IA in spite of staying in a protected environment.

Topics: Adolescent; Antifungal Agents; Antigens, Fungal; Aspergillosis; Case-Control Studies; Child; Chile; Cross Infection; Female; Galactose; Health Care Costs; Humans; Immunocompromised Host; Male; Mannans; Neoplasms; Opportunistic Infections; Retrospective Studies

Invasive aspergillosis (IA) is an important cause of mortality in patients with hematologic malignancies. However, IA appears to be gaining a foothold in the intensive care unit (ICU) in patients without classical risk factors. A recent study described 89 cases of IA in patients in a medical ICU without leukemia or cancer. The diagnosis of IA remains difficult and is often established too late. Galactomannan (GM) is an exo-antigen released from Aspergillus hyphae while they invade host tissue.. This prospective single-center study was conducted to investigate the role of GM in bronchoalveolar lavage (BAL) fluid as a tool for early diagnosis of IA in the ICU.. All patients with risk factors identified in our earlier study were evaluated. BAL for culture and GM detection, serum GM levels, and computed tomography scan were obtained for all included patients with signs of pneumonia. Patients were classified as having proven, probable, or possible IA.. A total of 110 patients out of 1,109 admissions were eligible. There were 26 proven IA cases. Using a cutoff index of 0.5, the sensitivity and specificity of GM detection in BAL fluid was 88 and 87%, respectively. The sensitivity of serum GM was only 42%. In 11 of 26 proven cases, BAL culture and serum GM remained negative, whereas GM in BAL was positive.. IA is common in immunocompromised, critically ill patients. GM detection in BAL fluid seems to be useful in establishing or excluding the diagnosis of IA in the ICU.

Topics: Adult; Aged; Aspergillosis; Bronchoalveolar Lavage Fluid; Bronchoscopy; Cause of Death; Cross Infection; Diagnosis, Differential; Female; Galactose; Hospital Mortality; Humans; Intensive Care Units; Lung; Lung Diseases, Fungal; Male; Mannans; Middle Aged; Mycological Typing Techniques; Opportunistic Infections; Pneumonia, Ventilator-Associated; Predictive Value of Tests; Prospective Studies; Survival Rate; Tomography, X-Ray Computed

Topics: Aspergillosis; Aspergillus; Bronchoalveolar Lavage Fluid; Cross Infection; Galactose; Hospital Mortality; Intensive Care Units; Lung Diseases, Fungal; Mannans; Opportunistic Infections; Pneumonia, Ventilator-Associated; Predictive Value of Tests; Survival Rate