Investigation of the presence of fungal agents in febrile neutropenic patients with different microbilogical methods

The prognosis of fungal infections in neutropenic patients is closely associated with early diagnosis. In this study it is aimed to investigate the fungal agents in febrile neutropenic patients. 101 adult patients, (64 female, 37 male) followed as Febrile Neutropeny diagnosis in Internal Medicine Hematology Polyclinic with hematological malignancies and using chemotherapeutic drugs were included to the study. Direct microscopic investigation and culture were performed in clinical samples during 199 episodes in patients. Galactomannan antigen (GM) was investigated with ELISA and the DNA of Aspergillus fumigatus and Candida albicans was investigated with real-time PCR in sequential serum samples sent in a week of all episodes of these patients. Of the 199 episodes followed by European Organization for Research on Treatment of Cancer/Mycoses Study Group a total of 5,5% was defined as absolute invasive fungal infection (AFI), 4% was defined as higher probability IA, 4% was defined lower probaility that 1,5% of these are absolute invasive aspergillosis (IA), 4% of are candidemy. The remaining 86,5% were not at higher risk for AFI. Candida spp was proliferated in 4.1% of blood cultures (4.1%), and in 25% of catheter cultures. When GM antigen test index accepted as 0.5ng/ml, GM antigen was found as negative in 86.43% of the episodes, found as one positive in 7.03% of the episodes, found as sequential two or more positive in 5.52% of the episodes and found as positive in any two serums in 1% of the episodes. While C.albicans DNA was not determined in 98.5% of 199 episodes, one positivity in 1% and sequential two and more positiveness were determined in 0.5% of the episodes. A.fumigatus PCR results of the 81.9% of the episodes determined as negative, 16.08% of the episodes determined as positive and positivity were determined in any two serums in 1% of the episodes and sequential positivity was determined in 1% of the episodes. GM antigen tests were found sequential positive in all three patients diagnosed as definite IA. We think that conventional, serological and molecular methods should be used for the detection of fungal agents in febrile neutropenic patients.