Utility of Serum Galactomanann Monitoring in Predicting Response to Empiric Antifungal therapy in Neutropenic Patients Following Intensive Chemotherapy

Abstract

Despite advances in antimicrobial therapy and supportive care, invasive fungal infection remains a major clinical problem among patients with hematologic malignancies. Not only are fungal infections increasing in frequency in this patient population, but they also are occurring earlier during the course of cytotoxic chemotherapy. The most common fungal infection is aspergillus 73%, candida 13%, and mucor 14% Groll AH, Shah PM et al., 1996.

Mortality from aspergillosis is variable but may be as high as 90 % despite therapy Richardson MD, et al., 1998.

Newer diagnostic approaches have focused on the detection of surrogate markers such as circulating fungal antigens or metabolites Roger TR, et al., 1990.

One such component is galactomannan (GM), a major aspergillar cell-wall constituent released during invasive disease.

In this study we evaluate the predictive value of serial serum galactomannan monitoring in predicting response to impiric anti-fungal therapy in febrile neutropenia patients, GM test is done on Days 1, 3, 5 and 9 of FN and systemic antifungal therapy starts on D4 of persistent fever, correlation between results of GM test and use of fungizone taking fever subside and clinical condition as parameters of response is done, the results revealed the test to have:

 Sensitivity: 88.88% PPV: 80 %  Specificity: 81.81% NPV: 90