Galactomannan as a Diagnostic Test for Invasive Pulmonary Aspergillosis in a Patient with Primary Immunodeficiency: Case Report
Main Article Content
Abstract
Introduction: Aspergillosis continues to be the most frequent fungal infection in the hematopoietic stem cell transplanted patient, however, in other types of immunocompromised states, such as primary immunodeficiencies, are scarce. Therefore, many times the diagnosis of invasive aspergillosis is often a diagnostic challenge for the clinician, so we highlight the usefulness of galactomannan in immunocompromised patients for the diagnosis of aspergillosis.
Background: Invasive aspergillosis together with chronic pulmonary aspergillosis and allergic bronchopulmonary aspergillosis, constitute the clinical forms of aspergillosis. Aspergillus fumigatus-complex is the most frequent etiological agent, the increase in immunosuppressive treatments and the greater use of corticoids have led to a greater prominence of aspergillosis in recent years. The use of galactomannan and imaging tests complement the microbiological limitations in the diagnosis of these patients, the mortality of invasive forms depends on the clinical form and the type of host.
Objective: To demonstrate the importance of galactomannan as a noninvasive diagnostic test for invasive pulmonary aspergillosis, in centers with limited resources where it is not possible to perform a histopathological study.
Case presentation: We present the case of an 18-year-old male patient with immunodeficiency due to T lymphocyte immunoregulation dysfunction, who developed invasive pulmonary aspergillosis with a positive galactomannan test.
Conclusions: Our case report reflects the diagnosis of ante-mortem invasive pulmonary aspergillosis in an adult patient with primary T-lymphocyte immunodeficiency, non-neutropenic, in whom a histopathological study to optimize the diagnosis was not possible, and whose only tool we had was the measurement of GM.
Abbreviations: GM= Galactomannan
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
References
I. Cadena J, Thompson GR, Patterson TF. Aspergilosis: Epidemiología, Diagnóstico y Tratamiento. Infectious Disease Clinics of North America. el 1 de junio de 2021;35(2):415-34.
II. Neofytos D, Horn D, Anaissie E, Steinbach W, Olyaei A, Fishman J, et al. Epidemiology and Outcome of Invasive Fungal Infection in Adult Hematopoietic Stem Cell Transplant Recipients: Analysis of Multicenter Prospective Antifungal Therapy (PATH) Alliance Registry. Clinical Infectious Diseases. el 1 de febrero de 2009;48(3):265-73.
III. Roosen J, Frans E, Wilmer A, Knockaert DC, Bobbaers H. Comparison of premortem clinical diagnoses in critically iII patients and subsequent autopsy findings. Mayo Clin Proc. junio de 2000;75(6):562-7.
IV. Tejerina EE, Abril E, Padilla R, Rodríguez Ruíz C, Ballen A, Frutos-Vivar F, et al. Aspergilosis invasora en pacientes críticos: Un estudio de autopsias. Micosis. agosto de 2019;62(8):673-9.
V. Bassetti M, Azoulay E, Kullberg BJ, Ruhnke M, Shoham S, Vázquez J, et al. Definiciones EORTC/MSGERC de enfermedades fúngicas invasivas: Resumen de Actividades del Grupo de Trabajo de la Unidad de Cuidados Intensivos. Clin Infect Dis. el 12 de marzo de 2021;72(Suppl 2):S121-7.
VI. Blot SI, Taccone FS, Van den Abeele AM, Bulpa P, Meersseman W, Brusselaers N, et al. A clinical algorithm to diagnose invasive pulmonary aspergillosis in critically ill patients. Am J Respir Crit Care Med. el 1 de julio de 2012;186(1):56-64.
VII. Lamoth F, Calandra T. Early diagnosis of invasive mould infections and disease. J Antimicrob Chemother. el 1 de marzo de 2017;72(suppl_1):i19–28.
VIII. Verweij PE, Rijnders BJA, Brüggemann RJM, Azoulay E, Bassetti M, Blot S, et al. Revisión de la aspergilosis pulmonar asociada a gripe en pacientes de UCI y propuesta de definición de caso: opinión de un experto. Intensive Care Med. agosto de 2020;46(8):1524-35.
IX. Sehgal IS, Dhooria S, Choudhary H, Aggarwal AN, Garg M, Chakrabarti A, et al. Utility of Serum and Bronchoalveolar Lavage Fluid Galactomannan in Diagnosis of Chronic Pulmonary Aspergillosis. J Clin Microbiol. el 27 de febrero de 2019;57(3):e01821-18.
X. Wu Z, Wang L, Tan L, Wu J, Chen Z, Hu M. Valor diagnóstico del galactomanano en suero y líquido de lavado broncoalveolar para la aspergilosis pulmonar invasiva en pacientes no neutropénicos. Diagnostic Microbiology and Infectious Disease. el 1 de abril de 2021;99(4):115274.
XI. Serin I, Dogu MH. Serum Aspergillus galactomannan lateral flow assay for the diagnosis of invasive aspergillosis: A singlecentre study. Mycoses. junio de 2021;64(6):678-83.
XII. Leeflang MMG, Debets-Ossenkopp YJ, Wang J, Visser CE, Scholten RJPM, Hooft L, et al. Detección de galactomanano para la aspergilosis invasiva en pacientes inmunocomprometidos. Cochrane Database Syst Rev. el 30 de diciembre de 2015;2015(12):CD007394.