Background: Patients with prolonged neutropenia and/or severe underlying immunosuppression are at the greatest risk for disseminated ASPERGILLOSIS. This study was undertaken to determine the incidence of INVASIVE ASPERGILLOSIS by Platelia Aspergillus enzyme-linked immunosorbent assay ELISA kit in high risk children admitted to the hematology ward of Dr. Faghihi hospital, Shiraz University of Medical Sciences, Iran.Materials and Methods: From Oct.2006 to Jun.2008, 62 patients with hematologic malignancies were followed and evaluated for INVASIVE ASPERGILLOSIS in Shiraz. All clinical samples were cultured and a direct microscopic examination was performed. Blood samples were cultured by bedside inoculation to BACTEC medium. Blood samples were collected prospectively once a week and stored at –20 oC until examination. All the collected blood samples were assayed for galactomannan antigen using Platelia Aspergillus ELISA kit. Patients were classified according to the diagnostic criteria set by the European Organization for Research and Treatment of Cancer-Mycosis Study Group.Results: The female-to-male ratio was 22: 40, and mean age of the patients was 9.3 years. The sensitivity, specificity, negative and positive predictive values of the ELISA method were 91%, 90%, 83.3%, and 94.7%, respectively. Galactomannan antigen test was positive in 1 proven, 8 probable, and 2 possible cases. The incidence rate of INVASIVE ASPERGILLOSIS was found to be 16.7%.Conclusion: Considering the incidence of INVASIVE ASPERGILLOSIS and the corresponding morbidity and mortality rates in patients with hematologic disorders, it seems that more efficient methods are in demand for early diagnosis and thereby promoting the patients’ survival.

Galactomannan (GM) antigen is an aspergillus specific antigen that is released during the growth phase of INVASIVE ASPERGILLOSIS. We aimed to find the optimum cut-off and accuracy of serum Galactomannan assay in immunocompromised patients.Immunocompromised patients diagnosed with INVASIVE pulmonary ASPERGILLOSIS (IPA) based on the European Organization for Research and Treatment of Cancer/INVASIVE Mycosis Study Group (EORTC/MSG) with three levels of certainty proven, probable and possible, referred for GM antigen measurement at Immunology, Asthma and Allergy Research Institute (IAARI) from 2006 to 2009 and if they met the criteria were enrolled in this study.Totally 49 patients with IPA were enrolled in our study. According to EORTC/MSG, patients categorized into three levels of certainty: They were diagnosed as ‘proven’ INVASIVE pulmonary ASPERGILLOSIS 16 (32.7%), ‘probable’ 18 (36.7%) and ‘possible’ 15 (30.6%). The most common host risk factor was solid tumors 17 (34.7%). The accuracy of Galactomannan assay increased from 0.5 to 2 cut-offs. The optimum sensitivity and specificity obtained at the index cut-off of: ³1.5 for diagnosis of “proven” IPA; which were respectively, 69.2% and 72.2%.Other cut-offs had high variance between sensitivity and specificity for diagnosis of IPA.The calculated cut-off gained by receiver operating characteristic (ROC) analysis for detecting proven IPA was 1.5. Intermediate accuracy of serum GM test in conjunct with clinical findings would help early IPA detection among immunocompromised patients.

Background: INVASIVE ASPERGILLOSIS is a major cause of morbidity and mortality in immunosuppressed patients. This infection is caused by Aspergillus, a hyaline mold, which is the etiologic agent for many different manifestations. Patient: A 63 year old diabetic housewife woman, living in northern Iran, presented with the history of right eye ptosis after a mild head trauma since about 3 weeks ago. She had positive history of intermittent headache several weeks before ptosis. On physical examination, the patient was afebrile and other vital signs were normal. Brain MRI showed a pituitary mass measuring about 4 cm. Pathological study showed hyphae in favor of ASPERGILLOSIS. Amphotericin B was started and after 10 days changed to itraconazole.Conclusion: It is important to consider fungal infection as a differential diagnosis of cerebral lesions even in the immunocompetent hosts. The clinical presentation of cerebral ASPERGILLOSIS is nonspecific and is characterized by focal neurologic signs, alteration in mental status and headache.