Analysis of the efficacy of bis(methyl)gliotoxin for early invasive aspergillosis detection and to guide antifungal treatment in neutropenic pediatric oncology patients
| Autor: | Domingo, María Pilar, Nabal, Sandra, Redrado, Sergio, López Gómez, Concepción, Rodríguez-Vigil, C., Muñoz Mellado, A., Calvo, Carlota, Rezusta, Antonio, Pardo, Julián, Gálvez Buerba, Eva Mª |
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| Přispěvatelé: | Gobierno de Aragón, Universidad de Zaragoza, Aspanoa, ARAID Foundation |
| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: | |
| Zdroj: | Digital.CSIC. Repositorio Institucional del CSIC instname |
| Popis: | of the poster presented at the 9th Trends in Medical Mycology (TIMM 2019), 11-14 October 2019, Nice (France).-- P152. [Objectives]: Invasive pulmonary aspergillosis (IPA) is a leading cause of morbidity and mortality in immunocompromised patients. This is due in part to the absence of optimal diagnostic modalities, which hamper early specific disease detection. Systemic detection of serum biomarkers is a standard noninvasive practice used to early diagnose and treat IPA in high risk population. During the last years, doubts have been raised regarding the use of galactomannan (GM) in onco-hematological population mainly due to the large number of patients with false positive test as well as the low efficacy in patients under antifungal profylaxis. In a previous study, we demonstrated the high diagnostic accuracy of bis(methyl)gliotoxin (bmGT) compared to GM for IPA diagnosis in adult oncohematological patients. However, the performance of bmGT as a diagnosis biomarker in pediatric patients is unknown. The objective of this study is to compare the ability of bmGT and GMN detection for IPA diagnosis in oncopediatric patients and to analyse the efficacy of bmGT to serve as guide for voriconazol treatment. [Methods]: The presence of bmGT and voriconazole levels in sequential series of serum from 7 oncopediatric patients at risk of IA (prospective samples) is simultaneously quantified by High Performance Thin Layer Chromatography (HPTLC) as well as LC/MS/MS. [Results]: We have established a fast and sensitive technique for simultaneous separation, detection and quantification of bmGT and voriconazole in serum and BAL of pediatric patients. bmGT and GM were negative in all possible IA cases (5 patients). Two patients, presenting prolonged neutropenia after chemotherapy treatment, fever, hypoxemia and pulmonary infiltration compatible with Aspergillosis in high resolution CT, were categorised as probable IA. GM and bmGT was monitored in serum and bronchoalveolar lavage. In one patient, GM and bmGT were detected in serum and with the voriconazole treatment GM was negativized and the bmGT levels decreased. bmGT was positive earlier than GM allowing early initiation of treatment. In the second patient, GM was negative and bmGT positive in both serum and BAL, so treatment with voriconazole was started. Treatment decreased bmGT values coinciding with the patient clinical improvement. [Conclusion]: BmGT has allowed us the early diagnosis and successful treatment of pediatric IA, being a promising tool for early detection of IA in neutropenic pediatric patients. |
| Databáze: | OpenAIRE |
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