Aspergillosis screening and treatment in patients with neutropenia

Nishma Singhal, MD, is an associate professor of medicine in the Faculty of Health Sciences and assistant dean for Continuing Health Sciences Education at McMaster University.

Should patients with neutropenia be screened for aspergillosis, eg, with periodic galactomannan testing? Is a positive galactomannan test result without abnormal radiologic findings an indication to initiate treatment in a patient with neutropenia?

There are multiple approaches to diagnosing and managing invasive mold infections or aspergillosis in patients with febrile neutropenia, and there’s both the preemptive as well as a prophylactic approach.

However, when it comes to the preemptive approach in patients who have, again, expected prolonged neutropenia of >10 days and may be at risk for aspergillosis, certainly doing serial galactomannan [tests] can be recommended with early radiographic investigation such as computed tomography (CT) of the lung or, if necessary, bronchoscopy as well, to diagnose aspergillosis in that population.

In terms of patients who have a positive galactomannan [test] in the absence of any symptoms—certainly if they have fever we would consider that a symptom and management and treatment would be initiated in those cases for the most part.

And in terms of a single isolated galactomannan [test], doing serial testing is often much more indicative of someone who’s at risk for developing invasive mold infections than one static value.