Aspergilose invasiva em pacientes imunodeprimidos: comparação entre as provas de galactomanana, 1,3 betaD-glucana, dados tomográficos e desfecho clínico / Performance of galactomannan and 1,3 beta-glucan enzyme assays in the serum and bronchoalveolar lavage and comparison with computer tomography scan for the diagnosis of invasive aspergillosis in immunocompromised hosts
São Paulo; s.n; 2015. [130] p. ilus, tab, graf.
Thesis
in Pt
| LILACS
| ID: biblio-870751
Responsible library:
BR66.1
Localization: BR66.1
RESUMO
A aspergilose invasiva (AI) é a infecção por fungos filamentosos mais comum em pacientes imunodeprimidos, especialmente em transplantes de células tronco hematopoiético e neoplasias hematológicas. Objetivo:
Geral Estabelecer a comparação entre a dosagem de Galactomanana (GM), 1,3betaD-glucana (BDG) e dados tomográficos no diagnóstico da AI bem como seu papel no desfecho clínico. Específicos 1. Verificar a sensibilidade e especificidade dos ensaios de Galactomanana e de 1,3betaD-glucana no soro e lavado broncoalveolar. 2. Comparar os resultados da galatomanana e 1,3betaD-glucana com os dados de imagem em pacientes com suspeita de AI. 3. Verificar a relação entre a evolução dos níveis de GM e desfecho clínico (óbito e sobrevida). Casuística,Materiais e Métodos:
Realizou-se um estudo tipo coorte prospectiva, incluindo 398 sujeitos das diversas enfermarias de pacientes imunodeprimidos do HCFMUSP, sendo incluídos dois grupos de pacientes 202(51%) AI e 198(49%) controles.Resultados:
Dos casos, 18 (8,8%) tinham aspergilose provada, 28 (13,7%) provável e 158 possível (77,5%), de acordo a classificação de 2002 EORTC/MSG (European Organization for Research and Treatment of Cancer / Mycoses Study Group). Os sujeitos submetidos ao TCTH eram 42,7%, com neoplasias hematológicas 37%, TOS 9% e outras doenças 11,3%. Os fatores de risco associados ao desenvolvimento da AI foram neutropenia, monocitopenia, uso de corticóide, presença de doença pelo citomegalovírus e rejeição ou doença do enxerto contra o hospedeiro. O fator de risco associado à evolução para o óbito foi a presença de AI. Foram observados bons desempenhos para a GM tanto no soro como no LBA com LR menores que os registrados na literatura. O melhor desempenho da GM no soro para aspergilose+provável ocorreu com LR de 0,35 com sensibilidade-S, especificidade-E, valor preditivo positivo- VPP), valor preditivo negativo-VPN) e área sob a curva-ASC de 54,4%, 73,4%, 50,8%, 76,2% e 0,64, sendo os valores superiores...ABSTRACT
Invasive aspergillosis (IA) has become the leading infectious cause of death in immunocompromised hosts, particularly in subjects under SCTH and hematologic neoplasias. Objectives:
General To compare the performance of GM and BG tests in serum and bronchoalveolar lavage fluid (BAL) and computer tomography (CT) scans in the diagnosis of IA in immunocompromised hosts as well as their role in the patient outcome. Specific 1. To analyse the sensitivity and specificity of Galactomannan and 1,3 betaD-glucan assays in the serum and bronchoalveolar lavage. 2. To compare the results of Galactomannan and 1,3betaD-glucan assays with CT scans in patients with invasive aspergilosis. 3. To analyse the relationship between the evolution of galactomannan levels and clinical outcome (death or survival). Patients, Materials andMethods:
From December 2008 to March 2013, a prospective cohort of 398 patients from several wards of immunocompromised patients of Hospital das Clínicas, Faculdade de Medicina, University of São Paulo was included classified in two groups of patients 202 (51%) with invasive aspergillosis (IA) and 198 (49%) control patients.Results:
Considering 202 cases, 18(8.8%) were subjects with proven, 28(13.7%) with probable aspergillosis and 156(77.5%), with possible aspergillosis, according to 2002 EORTC/MSG (European Organization for Research and Treatment of Cancer/Mycoses Study Group) criteria. The most common underlying disease were HSCT (42.7%), hematologic malignancy (37%), SOT (9%), or other diseases (11.3%). The main risk factors associated with IA were neutropenia, monocytopenia, patients under corticosterois, presence of CMV disease, and rejection or graft versus host disease. The risk factor associated with death was the presence of invasive aspergillosis. Good performances for serum and BAL GM were registered with lower cutoffs in the present workin relationship to those found in the literature. The best cutoff for proven + probable...Key words
Aspergillosis; Aspergilose pulmonar invasiva; Aspergilose; Beta-glucanas; Febrile neutropenia; Hematopoietic stem cell transplantation; Hospedeiro imunocomprometido; Immunocompromised host; Immunologic tests; Invasive pulmonary aspergillosis; Micoses; Mycoses; Neutropenia febril; Testes imunológicos; Tomografia computadorizada por raios X; Tomography; Transplante de células-tronco hematopoéticas; Transplante; Transplants; beta-Glucans
Full text:
1
Collection:
01-internacional
Database:
LILACS
Main subject:
Transplantation
/
Immunologic Tests
/
Tomography, X-Ray Computed
/
Immunocompromised Host
/
Hematopoietic Stem Cell Transplantation
/
Beta-Glucans
/
Invasive Pulmonary Aspergillosis
/
Febrile Neutropenia
/
Galactans
/
Mycoses
Type of study:
Diagnostic_studies
/
Prognostic_studies
/
Risk_factors_studies
Limits:
Humans
Language:
Pt
Year:
2015
Document type:
Thesis
Country of publication:
Brazil