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Montesinos I, Albichr IS, Collinge E, Delaere B, Huang TD, Bogaerts P, Deckers C, Hamouda M, Honoré PM, Bulpa P, Sonet A. Diagnostic Value of Serum Biomarkers for Invasive Aspergillosis in Haematologic Patients. J Fungi (Basel) 2024; 10:661. [PMID: 39330420 PMCID: PMC11433095 DOI: 10.3390/jof10090661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2024] [Revised: 09/17/2024] [Accepted: 09/18/2024] [Indexed: 09/28/2024] Open
Abstract
BACKGROUND Invasive aspergillosis (IA) is a significant cause of morbidity and mortality in patients with haematological malignancies. Accurate diagnosis of IA is challenging due to non-specific symptoms and the impact of antifungal prophylaxis on biomarker sensitivity. METHODS This retrospective study evaluated the diagnostic performance of three serum biomarkers: Aspergillus Galactomannan Ag VirClia Monotest® (VirClia), Wako β-D-Glucan Test® (Wako BDG), and MycoGENIE Real-Time PCR® (MycoGENIE PCR). True positives were defined as patients with proven or probable IA (n = 14), with a positive Platelia Aspergillus Antigen® (Platelia) serving as a mycological criterion. True negatives were identified as patients with a positive Platelia assay but classified as non-probable IA (n = 10) and outpatients who consistently tested negative with the Platelia test throughout the study period (n = 20). RESULTS Most patients diagnosed with proven or probable IA were acute myeloid leukaemia or myelodysplastic syndrome patients receiving mould-active antifungal prophylaxis or treatment (71%). VirClia demonstrated high sensitivity (100%) for detecting IA, with a specificity of 83%. Wako BDG and MycoGENIE PCR showed lower sensitivities for IA (57% and 64%, respectively). MycoGENIE PCR detected Aspergillus spp. and Mucorales in two patients. CONCLUSIONS Accurate diagnosis of IA remains challenging, especially in patients who have received mould-active antifungal treatment. VirClia showed comparable performance to Platelia, suggesting its potential for routine use. However, Wako BDG and MycoGENIE PCR results were less favourable in our study cohort. Nevertheless, MycoGENIE PCR detected two probable co-infections with Aspergillus spp. and Mucorales.
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Affiliation(s)
- Isabel Montesinos
- Laboratory Medicine-Microbiology, Centre Hospitalier Universitaire (CHU) Université Catholique de Louvain (UCL) Namur Site Godinne, 5530 Yvoir, Belgium
| | - Imane Saad Albichr
- Laboratory Medicine-Microbiology, Centre Hospitalier Universitaire (CHU) Université Catholique de Louvain (UCL) Namur Site Godinne, 5530 Yvoir, Belgium
| | - Elodie Collinge
- Haematological Department, Centre Hospitalier Universitaire (CHU) Université Catholique de Louvain (UCL) Namur Site Godinne, 5530 Yvoir, Belgium
| | - Bénédicte Delaere
- Infectiology Department, Centre Hospitalier Universitaire (CHU) Université Catholique de Louvain (UCL) Namur Site Godinne, 5530 Yvoir, Belgium
| | - Te-Din Huang
- Laboratory Medicine-Microbiology, Centre Hospitalier Universitaire (CHU) Université Catholique de Louvain (UCL) Namur Site Godinne, 5530 Yvoir, Belgium
| | - Pierre Bogaerts
- Laboratory Medicine-Microbiology, Centre Hospitalier Universitaire (CHU) Université Catholique de Louvain (UCL) Namur Site Godinne, 5530 Yvoir, Belgium
| | - Corentin Deckers
- Laboratory Medicine-Microbiology, Centre Hospitalier Universitaire (CHU) Université Catholique de Louvain (UCL) Namur Site Godinne, 5530 Yvoir, Belgium
| | - Mai Hamouda
- Pharmacy Faculty, Namur University, 5000 Namur, Belgium
| | - Patrick M Honoré
- Intensive Care Unit, Centre Hospitalier Universitaire (CHU) Université Catholique de Louvain (UCL) Namur Site Godinne, 5530 Yvoir, Belgium
| | - Pierre Bulpa
- Intensive Care Unit, Centre Hospitalier Universitaire (CHU) Université Catholique de Louvain (UCL) Namur Site Godinne, 5530 Yvoir, Belgium
| | - Anne Sonet
- Haematological Department, Centre Hospitalier Universitaire (CHU) Université Catholique de Louvain (UCL) Namur Site Godinne, 5530 Yvoir, Belgium
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2
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Gerard R, Gabriel F, Accoceberry I, Imbert S, Ducassou S, Angoso M, Jubert C. Is there still a place for serum galactomannan in the diagnosis of invasive aspergillosis in children at high risk and under antifungal prophylaxis? Mycoses 2024; 67:e13764. [PMID: 38970226 DOI: 10.1111/myc.13764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 06/21/2024] [Accepted: 06/27/2024] [Indexed: 07/08/2024]
Abstract
BACKGROUND The performance of serum galactomannan (GM) for the diagnosis of invasive aspergillosis (IA) has been studied mainly in adults. Paediatric data are scarce and based on small and heterogeneous cohorts. OBJECTIVE To evaluate the performance of serum GM for the diagnosis of IA in a paediatric oncologic population at high risk of IA and to clarify the impact of antifungal prophylaxis on this test. METHODS We performed a retrospective study from January 2014 to December 2020 in the paediatric oncologic haematologic department of the University Hospital of Bordeaux. The diagnosis of IA was made using the recommendations of the EORTC and the MSGERC. RESULTS Among the 329 periods at high risk of IA in 222 patients, the prevalence of IA was 1.8% (3 proven and 3 probable IA). In the total population, the sensitivity, and the positive predictive value (PPV) were respectively 50% and 17.6%. Under antifungal prophylaxis, the sensitivity and PPV dropped, respectively, to 33.3% and 14.3%. In this group, the post-test probability of IA was 2% for a negative serum GM and only 14%. CONCLUSION In this large cohort of children at high risk of IA, the incidence of IA is low and the diagnostic performance of GM is poor, especially in the case of mould-active prophylaxis. Screening should be targeted rather than systematic and should be reserved for patients at highest risk for IA without mould-active prophylaxis. Combination with other tests such as Aspergillus PCR would increase the accuracy of GM in screening setting.
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Affiliation(s)
- Rémy Gerard
- Pediatric Hematology Oncology Unit, Children Hospital, Bordeaux University Hospital, Bordeaux, France
| | - Frédéric Gabriel
- Laboratory of Parasitology-Mycology, Pellegrin Hospital, Bordeaux University Hospital, Bordeaux, France
| | - Isabelle Accoceberry
- Laboratory of Parasitology-Mycology, Pellegrin Hospital, Bordeaux University Hospital, Bordeaux, France
| | - Sébastien Imbert
- Laboratory of Parasitology-Mycology, Pellegrin Hospital, Bordeaux University Hospital, Bordeaux, France
| | - Stéphane Ducassou
- Pediatric Hematology Oncology Unit, Children Hospital, Bordeaux University Hospital, Bordeaux, France
| | - Marie Angoso
- Pediatric Hematology Oncology Unit, Children Hospital, Bordeaux University Hospital, Bordeaux, France
| | - Charlotte Jubert
- Pediatric Hematology Oncology Unit, Children Hospital, Bordeaux University Hospital, Bordeaux, France
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3
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Arora K, Sherilraj PM, Abutwaibe KA, Dhruw B, Mudavath SL. Exploring glycans as vital biological macromolecules: A comprehensive review of advancements in biomedical frontiers. Int J Biol Macromol 2024; 268:131511. [PMID: 38615867 DOI: 10.1016/j.ijbiomac.2024.131511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 04/02/2024] [Accepted: 04/09/2024] [Indexed: 04/16/2024]
Abstract
This comprehensive review delves into the intricate landscape of glycans and glycoconjugates, unraveling their multifaceted roles across diverse biological dimensions. From influencing fundamental cellular processes such as signaling, recognition, and adhesion to exerting profound effects at the molecular and genetic levels, these complex carbohydrate structures emerge as linchpins in cellular functions and interactions. The structural diversity of glycoconjugates, which can be specifically classified into glycoproteins, glycolipids, and proteoglycans, underscores their importance in shaping the architecture of cells. Beyond their structural roles, these molecules also play key functions in facilitating cellular communication and modulating recognition mechanisms. Further, glycans and glycoconjugates prove invaluable as biomarkers in disease diagnostics, particularly in cancer, where aberrant glycosylation patterns offer critical diagnostic cues. Furthermore, the review explores their promising therapeutic applications, ranging from the development of glycan-based nanomaterials for precise drug delivery to innovative interventions in cancer treatment. This review endeavors to comprehensively explore the intricate functions of glycans and glycoconjugates, with the primary goal of offering valuable insights into their extensive implications in both health and disease. Encompassing a broad spectrum of biological processes, the focus of the review aims to provide a comprehensive understanding of the significant roles played by glycans and glycoconjugates.
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Affiliation(s)
- Kanika Arora
- Infectious Disease Biology Laboratory, Institute of Nano Science & Technology (INST), Sector 81, Mohali, Punjab 140306, India
| | - P M Sherilraj
- Infectious Disease Biology Laboratory, Institute of Nano Science & Technology (INST), Sector 81, Mohali, Punjab 140306, India
| | - K A Abutwaibe
- Infectious Disease Biology Laboratory, Institute of Nano Science & Technology (INST), Sector 81, Mohali, Punjab 140306, India
| | - Bharti Dhruw
- Infectious Disease Biology Laboratory, Institute of Nano Science & Technology (INST), Sector 81, Mohali, Punjab 140306, India
| | - Shyam Lal Mudavath
- Infectious Disease Biology Laboratory, Institute of Nano Science & Technology (INST), Sector 81, Mohali, Punjab 140306, India; Department of Animal Biology, School of Life Sciences, University of Hyderabad, Prof. C.R. Rao Road, Gachibowli Hyderabad 500046, Telangana, India.
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4
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Friedman DZP, Theel ES, Walker RC, Vikram HR, Razonable RR, Vergidis P. Serial Bronchoalveolar Lavage Fluid Aspergillus Galactomannan and Treatment Response in Invasive Pulmonary Aspergillosis. Open Forum Infect Dis 2024; 11:ofae114. [PMID: 38560609 PMCID: PMC10977621 DOI: 10.1093/ofid/ofae114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 02/28/2024] [Indexed: 04/04/2024] Open
Abstract
We studied patients diagnosed with aspergillosis based on positive bronchoalveolar lavage (BAL) Aspergillus galactomannan (GM) who had follow-up BAL sampling within 180 days. GM trend and clinical outcome were concordant in only 60% (30/50). While useful for the initial diagnosis, BAL GM trending does not always correlate with treatment response.
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Affiliation(s)
- Daniel Z P Friedman
- Section of Infectious Disease, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Section of Infectious Diseases and Public Health, University of Chicago, Chicago, Illinois, USA
| | - Elitza S Theel
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Randall C Walker
- Section of Infectious Disease, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Raymund R Razonable
- Section of Infectious Disease, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
- William J von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, Minnesota, USA
| | - Paschalis Vergidis
- Section of Infectious Disease, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
- William J von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, Minnesota, USA
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Aerts R, Cuypers L, Mercier T, Maertens J, Lagrou K. Implementation of Lateral Flow Assays for the Diagnosis of Invasive Aspergillosis in European Hospitals: A Survey from Belgium and a Literature Review of Test Performances in Different Patient Populations. Mycopathologia 2023; 188:655-665. [PMID: 37209228 DOI: 10.1007/s11046-023-00739-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 04/15/2023] [Indexed: 05/22/2023]
Abstract
OBJECTIVES Diagnosis of invasive aspergillosis is based on a combination of criteria, of which the detection of Aspergillus galactomannan (GM) often is decisive. To date, the most commonly used method to determine GM is an enzyme-linked immune assay (EIA). But since a few years lateral flow assays (LFAs) were introduced, providing the possibility for rapid single sample testing. More and more LFAs are entering the market, but, although often being equated, all use their own antibodies, procedures and interpretation criteria. A recent European survey revealed that about 24-33% of laboratories implemented a lateral flow assay on-site. METHODS We conducted a survey at 81 Belgian hospital laboratories regarding the implementation of LFAs in their centre. In addition, we performed an extensive review of all publicly available studies on the performance of lateral flow assays to diagnose invasive aspergillosis. RESULTS Response rate to the survey was 69%. Of the 56 responding hospital laboratories, 6 (11%) used an LFA. The Soña Aspergillus galactomannan LFA (IMMY, Norman, Oklahoma, USA) was used in 4/6 centres, while two centres used the QuicGM (Dynamiker, Tianjin, China) and one centre used the FungiXpert Aspergillus Galactomannan Detection K-set LFA (Genobio [Era Biology Technology], Tianjin, China). One centre used 2 distinct LFAs. In 3/6 centres, the sample is sent to another lab for confirmation with GM-EIA when the LFA result is positive and in 2/6 when the LFA results is negative. In one centre, a confirmatory GM-EIA is always performed in house. In three centres the LFA result is used as a complete substitute for GM-EIA. Available LFA performance studies are very diverse and results vary in function of the study population and type of LFA. Apart from the IMMY and OLM LFA, only very limited performance data are available. From two out of three LFAs used in Belgium, no clinical performance studies are published in literature. CONCLUSIONS A large variety of LFAs are used in Belgian Hospitals, some of which no clinical validation studies are published. These results do likely have implications for other parts of Europe and for the rest of the world as well. Due to the variable performance of LFA tests and the limited validation data available, each laboratory must check the available performance information of the specific test considered for implementation. In addition, laboratories should perform an implementation verification study.
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Affiliation(s)
- Robina Aerts
- Department of Internal Medicine, University Hospitals Leuven, Leuven, Belgium
- Laboratory of Clinical Microbiology, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Lize Cuypers
- Laboratory of Clinical Microbiology, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
- Department of Laboratory Medicine, National Reference Center for Mycosis, University Hospitals Leuven, Leuven, Belgium
| | - Toine Mercier
- Laboratory of Clinical Microbiology, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
- Department of Haematology, General Hospital Sint-Maarten, Mechelen, Belgium
| | - Johan Maertens
- Laboratory of Clinical Microbiology, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
- Department of Haematology, University Hospitals Leuven, Leuven, Belgium
| | - Katrien Lagrou
- Laboratory of Clinical Microbiology, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium.
- Department of Laboratory Medicine, National Reference Center for Mycosis, University Hospitals Leuven, Leuven, Belgium.
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Mota SM, Girling SJ, Cole G, Brown D, Johnson G, Naylor AD. APPLICATION OF A NOVEL ASPERGILLUS LATERAL-FLOW DEVICE IN THE DIAGNOSIS OF ASPERGILLOSIS IN CAPTIVE GENTOO PENGUINS ( PYGOSCELIS PAPUA PAPUA). J Zoo Wildl Med 2023; 54:360-366. [PMID: 37428700 DOI: 10.1638/2021-0158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2022] [Indexed: 07/12/2023] Open
Abstract
Aspergillosis is the primary fungal disease affecting captive penguins globally. Its diagnosis remains challenging, and currently no tests are both sensitive and specific for the detection of early infection. The present study evaluated a recently developed Aspergillus lateral-flow device (AspLFD) for the detection of Aspergillus spp. antigen in plasma and glottis mucus from captive penguins. In a pilot retrospective study, banked frozen plasma samples from captive penguins were reviewed: samples from 11 gentoo penguins (Pygoscelis papua papua) and 4 king penguins (Aptenodytes patagonicus) fulfilled the inclusion criteria and were used in the analysis. Positive plasma AspLFD test results were found in 80% (four of five) of the aspergillosis-positive cases tested. All of the aspergillosis-negative cases tested negative (10 of 10) on the AspLFD test. In a cohort prospective study, paired plasma and glottis swab samples were opportunistically and nonrandomly collected from captive gentoo penguins. In total, 26 penguins were tested. In the negative control group, AspLFD test was negative on plasma and swab in 100% of birds (14 of 14). In the aspergillosis-positive group, AspLFD test was positive on plasma samples from 33% (4 of 12) of birds, on swab samples from 50% (6 of 12) of birds, and on either plasma or swab samples from 75% (9 of 12) of birds. The AspLFD is currently used for the diagnosis of aspergillosis in humans and also shows promise for use in penguins. Larger prospective studies are recommended.
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Affiliation(s)
- Stéphanie M Mota
- Veterinary Department, Royal Zoological Society of Scotland (RZSS), Edinburgh Zoo, Edinburgh, EH12 6TS, United Kingdom,
| | - Simon J Girling
- Veterinary Department, Royal Zoological Society of Scotland (RZSS), Edinburgh Zoo, Edinburgh, EH12 6TS, United Kingdom
| | - Georgina Cole
- Veterinary Department, Royal Zoological Society of Scotland (RZSS), Edinburgh Zoo, Edinburgh, EH12 6TS, United Kingdom
| | - Donna Brown
- Veterinary Department, Royal Zoological Society of Scotland (RZSS), Edinburgh Zoo, Edinburgh, EH12 6TS, United Kingdom
| | - Gemma Johnson
- OLM Diagnostics, Newcastle upon Tyne, NE4 5TF, United Kingdom
| | - Adam D Naylor
- Veterinary Department, Royal Zoological Society of Scotland (RZSS), Edinburgh Zoo, Edinburgh, EH12 6TS, United Kingdom
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7
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Rothe K, Dibos M, Haschka SJ, Schmid RM, Busch D, Rasch S, Lahmer T. Galactomannan-Antigen Testing from Non-Directed Bronchial Lavage for Rapid Detection of Invasive Pulmonary Aspergillosis in Critically Ill Patients: A Proof-of-Concept Study. Diagnostics (Basel) 2023; 13:diagnostics13061190. [PMID: 36980499 PMCID: PMC10047239 DOI: 10.3390/diagnostics13061190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/09/2023] [Accepted: 03/18/2023] [Indexed: 03/30/2023] Open
Abstract
Invasive pulmonary aspergillosis is associated with high mortality. For diagnosis, galactomannan-antigen in serum and bronchoalveolar lavage fluid is recommended, with higher sensitivity in bronchoalveolar lavage fluid. Because of invasiveness, bronchoalveolar lavage might be withheld due to patients' or technical limitations, leading to a delay in diagnosis while early diagnosis is crucial for patient outcome. To address this problem, we performed an analysis of patient characteristics of intubated patients with invasive pulmonary aspergillosis with comparison of galactomannan-antigen testing between non-directed bronchial lavage (NBL) and bronchoalveolar lavage fluid. A total of 32 intubated ICU patients with suspected invasive pulmonary aspergillosis could be identified. Mycological cultures were positive in 37.5% for A. fumigatus. Galactomannan-antigen in NBL (ODI 4.3 ± 2.4) and bronchoalveolar lavage fluid (ODI 3.6 ± 2.2) showed consistent results (p-value 0.697). Galactomannan-antigen testing for detection of invasive pulmonary aspergillosis using deep tracheal secretion showed comparable results to bronchoalveolar lavage fluid. Because of widespread availability in intubated patients, galactomannan-antigen from NBL can be used as a screening parameter in critical risk groups with high pretest probability for invasive aspergillosis to accelerate diagnosis and initiation of treatment. Bronchoalveolar lavage remains the gold standard for diagnosis of invasive aspergillosis to be completed to confirm diagnosis, but results from NBL remove time sensitivity.
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Affiliation(s)
- Kathrin Rothe
- Institute for Medical Microbiology, Immunology and Hygiene, School of Medicine, Technical University of Munich, 81675 Munich, Germany
- Institut Für Laboratoriumsmedizin, Medizinische Mikrobiologie und Technische Hygiene München Klinik, Sektion Mikrobiologie, 81377 Munich, Germany
| | - Miriam Dibos
- Department of Internal Medicine II, School of Medicine, Technical University of Munich, 81675 Munich, Germany
| | - Stefanie J Haschka
- Department of Internal Medicine II, School of Medicine, Technical University of Munich, 81675 Munich, Germany
| | - Roland M Schmid
- Department of Internal Medicine II, School of Medicine, Technical University of Munich, 81675 Munich, Germany
| | - Dirk Busch
- Department of Internal Medicine II, School of Medicine, Technical University of Munich, 81675 Munich, Germany
| | - Sebastian Rasch
- Department of Internal Medicine II, School of Medicine, Technical University of Munich, 81675 Munich, Germany
| | - Tobias Lahmer
- Department of Internal Medicine II, School of Medicine, Technical University of Munich, 81675 Munich, Germany
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Karunanithy R, Ratnasingam S, Holland T, Sivakumar P. Sensitive Detection of the Human Epididymis Protein-4 (HE4) Ovarian Cancer Biomarker through a Sandwich-Type Immunoassay Method with Laser-Induced Breakdown Spectroscopy. Bioconjug Chem 2023; 34:501-509. [PMID: 36762387 DOI: 10.1021/acs.bioconjchem.2c00551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Detection of cancer before the appearance of any symptoms is crucial for successful treatment. Early detection is, however, very challenging, particularly for the types of cancer with few or no symptoms at early stages, such as epithelial ovarian cancer (EOC). Developing a user-friendly method that can detect biomarkers with sufficient selectivity, sensitivity, and reproducibility is a promising approach for overcoming the challenges of early detection of EOC. In this study, we report a sandwich-type microparticle immunoassay for sensitive detection of the HE4 biomarker with laser-induced breakdown spectroscopy. Here, we cross-linked elemental particles to a specific functional group of the targeted biomolecules based on a covalent and non-covalent linking chemistry to improve the sensitivity and selectivity of biomarker detection, in which Fe3O4 and SiO2 microparticles were used to conjugate and purify the antibody-antigen in complex media. Simultaneous detection of Fe and Si from a magnetically purified assay significantly improves the HE4 biomarker's detectability, in which HE4 was detected with a limit of detection of 0.0022 pM. We also determined the coupling ratio between HE4 and silica particles using a silicon calibration curve.
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Affiliation(s)
- Robinson Karunanithy
- School of Physics and Applied Physics, Southern Illinois University Carbondale, Carbondale, Illinois 62901, United States
| | - Suthakaran Ratnasingam
- Department of Mathematics, California State University, San Bernardino, California 92407, United States
| | - Torrey Holland
- School of Physics and Applied Physics, Southern Illinois University Carbondale, Carbondale, Illinois 62901, United States
- Department of Life and Physical Science, John A. Logan College, 700 Logan College Dr., Carterville, Illinois 62918, United States
| | - Poopalasingam Sivakumar
- School of Physics and Applied Physics, Southern Illinois University Carbondale, Carbondale, Illinois 62901, United States
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9
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Kanodia A, Bhalla AS, Singh G, Xess I, Valappil BV, Kakkar A, Budhiraja S, Sikka K, Irugu DVK, Thakar A, Verma H. The Role of Serum Galactomannan Assay as a Potential Surrogate Biomarker for Fungal Microinvasion in Allergic Fungal Rhinosinusitis. Indian J Otolaryngol Head Neck Surg 2023; 75:49-53. [PMID: 37007877 PMCID: PMC10050302 DOI: 10.1007/s12070-023-03489-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 01/12/2023] [Indexed: 01/30/2023] Open
Abstract
We conducted this study to determine if serum galactomannan (GM) can be used as a marker to implicate the invasiveness of allergic fungal rhinosinusitis (AFRS), and correlate this value with the aggressiveness of disease documented via computed tomography (CT). All paranasal CT scans done for AFRS patients prospectively over a five-year period (2015-2019) were included. An indigenous 20-point score was used to document the extent of bone erosion seen on CT, wherein a higher score meant a greater extent of bone erosion. It was then correlated with serum GM scores. The median CT scores of galactomannan-positive (GM+) patients were compared with the median CT scores of galactomannan-negative (GM-) patients 3 using Mann-Whitney U test. The patients were divided into five groups based on the extent of disease-No bone erosion, erosion of only sinus wall/orbit, 3 erosion of orbit and skull base, erosion of only skull base and lateral extension of disease into infratemporal fossa (ITF). Subgroup analysis was conducted over mean GM values in these groups using ANOVA test. p-value < 0.05 was considered significant. Statistical analysis was performed using SPSS version 25.0. A total of 92 patients were included (56 males, 36 females). No statistically significant difference was found (p-value = 0.42) between the CT scores of galactomannan-positive (GM+) group and galactomannan-negative (GM-) group. The mean GM scores amongst the five sub-groups did not show a statistically significant difference. Serum galactomannan values correlate poorly with aggressiveness of disease quantified on non-contrast CT of paranasal sinuses.
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Affiliation(s)
- Anupam Kanodia
- Department of Otorhinolaryngology and Head-Neck Surgery, Room no 4057, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, Delhi 110029 India
| | - Ashu Seith Bhalla
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Gagandeep Singh
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Immaculata Xess
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Bashid Valia Valappil
- Department of Otorhinolaryngology and Head-Neck Surgery, Room no 4057, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, Delhi 110029 India
| | - Aanchal Kakkar
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Shilpi Budhiraja
- Department of Otorhinolaryngology and Head-Neck Surgery, Room no 4057, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, Delhi 110029 India
| | - Kapil Sikka
- Department of Otorhinolaryngology and Head-Neck Surgery, Room no 4057, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, Delhi 110029 India
| | - David Victor Kumar Irugu
- Department of Otorhinolaryngology and Head-Neck Surgery, Room no 4057, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, Delhi 110029 India
| | - Alok Thakar
- Department of Otorhinolaryngology and Head-Neck Surgery, Room no 4057, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, Delhi 110029 India
| | - Hitesh Verma
- Department of Otorhinolaryngology and Head-Neck Surgery, Room no 4057, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, Delhi 110029 India
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10
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Wang Y, Liu Y, Jiang S, Zhao Y, Cai J, Hao W, Fu N. Antifungal antibodies present in intravenous immunoglobulin derived from China. Braz J Microbiol 2023; 54:81-92. [PMID: 36602749 PMCID: PMC9944592 DOI: 10.1007/s42770-022-00894-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 12/16/2022] [Indexed: 01/06/2023] Open
Abstract
Fungal infections usually occur in immunocompromised patients. Intravenous immunoglobulin (IVIG) has been used as therapeutic interventions for many infectious diseases, but seldom applied in mycosis due to unknown antifungal specificity. This study aims to determine the presence of antifungal antibodies in IVIG. Binding reactivity of IVIG with crude and recombinant antigens of Candida albicans, Aspergillus fumigatus, Cryptococcus neoformans and Talaromyces marneffei were observed in a dose-dependent manner, similar with mixed normal human sera. The antifungal specificity was further confirmed by competitive enzyme-linked immunosorbent assays (ELISA) inhibited by rabbit specific antifungal polyclonal antibodies (PAbs) and homogenous crude antigens with inhibitions of 65.5-87.2% and 73.1-94.2%, respectively. Moreover, IVIG also reacted with fungal glycoproteins (Csa2, Cpl1 and Mp1p) in a dose-dependent way, which was inhibited by specific rabbit PAbs and homogenous antigens with different inhibitions and pulled down 72.8-83.8% of specific antibodies if preabsorption IVIG with Dynabeads® coupled with homogenous glycoproteins. These results furthermore verified the antifungal specificity of IVIG. Among four brands of IVIG, there was different antifungal IgG against C. albicans (P < 0.05) and C. neoformans (P < 0.05), while no difference for A. fumigatus (P = 0.086) and T. marneffei (P = 0.057). IVIG contained a significantly higher level of specific IgG for C. albicans than other three fungi (P <0.001). In conclusion, we proved antifungal IgG against C. albicans, A. fumigatus, C. neoformans and T. marneffei present in IVIG, which might be expected to provide a possible immunoregulation choice for mycosis and an evaluation to humoral immunity against fungi.
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Affiliation(s)
- Yanfang Wang
- Innovation Platform for In Vitro Diagnosis of Guangdong Province, Zhujiang Hospital, Southern Medical University, Guangzhou, 510282, Guangdong, China.
- Microbiome Medicine Center, Department of Laboratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, 510282, Guangdong, China.
| | - Yugu Liu
- Innovation Platform for In Vitro Diagnosis of Guangdong Province, Zhujiang Hospital, Southern Medical University, Guangzhou, 510282, Guangdong, China
- Microbiome Medicine Center, Department of Laboratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, 510282, Guangdong, China
| | - Susu Jiang
- Innovation Platform for In Vitro Diagnosis of Guangdong Province, Zhujiang Hospital, Southern Medical University, Guangzhou, 510282, Guangdong, China
- Microbiome Medicine Center, Department of Laboratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, 510282, Guangdong, China
| | - Yan Zhao
- Innovation Platform for In Vitro Diagnosis of Guangdong Province, Zhujiang Hospital, Southern Medical University, Guangzhou, 510282, Guangdong, China
- Microbiome Medicine Center, Department of Laboratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, 510282, Guangdong, China
| | - Jianpiao Cai
- State Key Laboratory of Emerging Infectious Diseases, Department of Microbiology, The University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
| | - Wei Hao
- Innovation Platform for In Vitro Diagnosis of Guangdong Province, Zhujiang Hospital, Southern Medical University, Guangzhou, 510282, Guangdong, China
- Microbiome Medicine Center, Department of Laboratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, 510282, Guangdong, China
| | - Ning Fu
- Innovation Platform for In Vitro Diagnosis of Guangdong Province, Zhujiang Hospital, Southern Medical University, Guangzhou, 510282, Guangdong, China
- Microbiome Medicine Center, Department of Laboratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, 510282, Guangdong, China
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11
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Maertens J, Lodewyck T, Donnelly JP, Chantepie S, Robin C, Blijlevens N, Turlure P, Selleslag D, Baron F, Aoun M, Heinz WJ, Bertz H, Ráčil Z, Vandercam B, Drgona L, Coiteux V, Llorente CC, Schaefer-Prokop C, Paesmans M, Ameye L, Meert L, Cheung KJ, Hepler DA, Loeffler J, Barnes R, Marchetti O, Verweij P, Lamoth F, Bochud PY, Schwarzinger M, Cordonnier C. Empiric vs Preemptive Antifungal Strategy in High-Risk Neutropenic Patients on Fluconazole Prophylaxis: A Randomized Trial of the European Organization for Research and Treatment of Cancer. Clin Infect Dis 2023; 76:674-682. [PMID: 35906831 PMCID: PMC9938744 DOI: 10.1093/cid/ciac623] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 07/12/2022] [Accepted: 07/27/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Empiric antifungal therapy is considered the standard of care for high-risk neutropenic patients with persistent fever. The impact of a preemptive, diagnostic-driven approach based on galactomannan screening and chest computed tomography scan on demand on survival and on the risk of invasive fungal disease (IFD) during the first weeks of high-risk neutropenia is unknown. METHODS Patients with acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS) and allogeneic hematopoietic cell transplant recipients were randomly assigned to receive caspofungin empirically (arm A) or preemptively (arm B), while receiving fluconazole 400 mg daily prophylactically. The primary end point of this noninferiority study was overall survival (OS) 42 days after randomization. RESULTS Of 556 patients recruited, 549 were eligible: 275 in arm A and 274 in arm B. Eighty percent of the patients had AML or MDS requiring high-dose chemotherapy, and 93% of them were in the first induction phase. At day 42, the OS was not inferior in arm B (96.7%; 95% confidence interval [CI], 93.8%-98.3%) when compared with arm A (93.1%; 95% CI, 89.3%-95.5%). The rates of IFDs at day 84 were not significantly different, 7.7% (95% CI, 4.5%-10.8%) in arm B vs 6.6% (95% CI, 3.6%-9.5%) in arm A. The rate of patients who received caspofungin was significantly lower in arm B (27%) than in arm A (63%; P < .001). CONCLUSIONS The preemptive antifungal strategy was safe for high-risk neutropenic patients given fluconazole as prophylaxis, halving the number of patients receiving antifungals without excess mortality or IFDs. Clinical Trials Registration. NCT01288378; EudraCT 2010-020814-27.
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Affiliation(s)
- Johan Maertens
- Correspondence: J. Maertens, University Hospitals Leuven, Herestraat 49, B-3000, Leuven, Belgium ()
| | - Tom Lodewyck
- Department of Hematology, Algemeen Ziekenhuis St Jan, Brugge, Belgium
| | - J Peter Donnelly
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Christine Robin
- Department of Hematology, Centre Hospitalier Universitaire Henri Mondor, Créteil, France
| | - Nicole Blijlevens
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Pascal Turlure
- Department of Hematology, Centre Hospitalier Universitaire Limoges, Limoges, France
| | - Dominik Selleslag
- Department of Hematology, Algemeen Ziekenhuis St Jan, Brugge, Belgium
| | - Frédéric Baron
- Department of Hematology, University of Liège and University Hospital of Liège, Liège, Belgium
| | - Mickael Aoun
- Department of Internal Medicine, Institut Jules Bordet, Brussels, Belgium
| | - Werner J Heinz
- Department of Hematology/Oncology, Caritas Hospital, Bad Mergentheim, Germany
| | - Hartmut Bertz
- Department of Hematology/Oncology, Faculty of Medicine and Medical Centre, University of Freiburg, Freiburg, Germany
| | - Zdeněk Ráčil
- Department of Hematology, Masaryk University Brno and Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Bernard Vandercam
- Department of Internal Medicine/Infectious Diseases, Cliniques Universitaires St. Luc, Brussels, Belgium
| | - Lubos Drgona
- Department of Oncohematology, Comenius University and National Cancer Institute, Bratislava, Slovakia
| | - Valerie Coiteux
- Service des maladies du sang, Centre Hospitalier Régional Universitaire Lille, Lille, France
| | | | | | - Marianne Paesmans
- Department of Internal Medicine, Institut Jules Bordet, Brussels, Belgium
| | - Lieveke Ameye
- Department of Internal Medicine, Institut Jules Bordet, Brussels, Belgium
| | - Liv Meert
- European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium
| | - Kin Jip Cheung
- European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium
| | | | - Jürgen Loeffler
- Department of Internal Medicine II, Universitaetsklinikum, Würzburg, Germany
| | - Rosemary Barnes
- Department of Infection, Immunity and Biochemistry, Cardiff University, Cardiff, United Kingdom
| | - Oscar Marchetti
- Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland
- Department of Infectious Diseases, Ensemble Hospitalier de la Côte, Morges, Switzerland
| | - Paul Verweij
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Frederic Lamoth
- Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Pierre-Yves Bochud
- Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Michael Schwarzinger
- Translational Health Economics Network, Bordeaux University Hospital, Bordeaux, France
| | - Catherine Cordonnier
- Department of Hematology, Centre Hospitalier Universitaire Henri Mondor, Créteil, France
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12
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Long-Term Kinetics of Serum Galactomannan during Treatment of Complicated Invasive Pulmonary Aspergillosis. J Fungi (Basel) 2023; 9:jof9020157. [PMID: 36836274 PMCID: PMC9965572 DOI: 10.3390/jof9020157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 01/19/2023] [Accepted: 01/19/2023] [Indexed: 01/26/2023] Open
Abstract
Several studies have evaluated the serum galactomannan (GM) antigen assay in pediatric patients, and there is convincing evidence for its usefulness as a diagnostic tool for invasive Aspergillus infections in patients with acute leukemias or post allogeneic hematopoietic cell transplantation (HCT). Less is known about the utility of the assay in monitoring responses to treatment in patients with established invasive aspergillosis (IA). Here, we present the long-term kinetics of serum galactomannan in two severely immunocompromised adolescents with invasive pulmonary aspergillosis (IPA) who were cured after complicated clinical courses. We also review the utility of the GM antigen assay in serum as a prognostic tool around the time of diagnosis of IA and as a biomarker to monitor disease activity in patients with established IA and assess responses to systemic antifungal therapy.
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13
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Chen W, Ji Y, Hong X, Zhu Y, Gou X, Chen M, Lv H, Ge Y. Pacemaker Associated Aspergillus fumigatus Endocarditis: A Case Report. Infect Drug Resist 2023; 16:329-335. [PMID: 36704772 PMCID: PMC9871031 DOI: 10.2147/idr.s393917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 01/07/2023] [Indexed: 01/19/2023] Open
Abstract
Aspergillus endocarditis (AE) is a highly fatal infection that can occur in heart valve replacement, pacemaker implantation and other heart surgeries, and early recognition and sufficient diagnosis are challenging. Here, we report the case of a 68-year-old male with a history of dilated cardiomyopathy and pacemaker implantation who had a repeated fever with failed antibacterial treatment and sterile blood culture. He developed endocarditis, and the culture and biopsy of vegetation tissue showed the abundant presence of septate hyphae, which was subsequently identified as Aspergillus fumigatus by internal transcribed spacer (ITS) sequencing. Although the patient had serious side effects from voriconazole, he had a good prognosis following surgery and prolonged caspofungin antifungal therapy of 42 consecutive days. We discuss the diagnosis and treatment strategy of AE, and recommend galactomannan assays and next-generation sequencing for a timely diagnosis. Early surgical intervention combined with prompt antifungal therapy appears significant for survival.
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Affiliation(s)
- Wanyuan Chen
- Department of Pathology, Cancer Center, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, 310014, People’s Republic of China,Department of Clinical Laboratory, Laboratory Medicine Center, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, 310014, People’s Republic of China
| | - Youqi Ji
- Department of Clinical Laboratory, Laboratory Medicine Center, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, 310014, People’s Republic of China
| | - Xin Hong
- Department of Clinical Laboratory, Laboratory Medicine Center, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, 310014, People’s Republic of China
| | - Yongze Zhu
- Department of Clinical Laboratory, Laboratory Medicine Center, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, 310014, People’s Republic of China
| | - Xiaoyu Gou
- Department of Clinical Laboratory, Laboratory Medicine Center, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, 310014, People’s Republic of China
| | - Mengyuan Chen
- Department of Clinical Laboratory, Laboratory Medicine Center, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, 310014, People’s Republic of China
| | - Huoyang Lv
- Department of Clinical Laboratory, Laboratory Medicine Center, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, 310014, People’s Republic of China
| | - Yumei Ge
- Department of Pathology, Cancer Center, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, 310014, People’s Republic of China,Department of Clinical Laboratory, Laboratory Medicine Center, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, 310014, People’s Republic of China,Key Laboratory of Biomarkers and in vitro Diagnosis Translation of Zhejiang Province, Hangzhou, 310063, People’s Republic of China,Correspondence: Yumei Ge, Department of Clinical Laboratory, Laboratory Medicine Center, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, No. 158, Shang-Tang Road, Gong-Shu District, Hangzhou, Zhejiang, 310014, People’s Republic of China, Tel +86-0571-85893264, Email
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14
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Townsend L, Martin-Loeches I. Invasive Aspergillosis in the Intensive Care Unit. Diagnostics (Basel) 2022; 12:2712. [PMID: 36359555 PMCID: PMC9689891 DOI: 10.3390/diagnostics12112712] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/02/2022] [Accepted: 11/04/2022] [Indexed: 08/28/2023] Open
Abstract
Invasive pulmonary aspergillosis (IPA) is a serious condition resulting in significant mortality and morbidity among patients in intensive care units (ICUs). There is a growing number of at-risk patients for this condition with the increasing use of immunosuppressive therapies. The diagnosis of IPA can be difficult in ICUs, and relies on integration of clinical, radiological, and microbiological features. In this review, we discuss patient populations at risk for IPA, as well as the diagnostic criteria employed. We review the fungal biomarkers used, as well as the challenges in distinguishing colonization with Aspergillus from invasive disease. We also address the growing concern of multidrug-resistant Aspergillosis and review the new and novel therapeutics which are in development to combat this.
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Affiliation(s)
- Liam Townsend
- Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St. James’s Hospital, D08 NHY1 Dublin, Ireland
| | - Ignacio Martin-Loeches
- Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St. James’s Hospital, D08 NHY1 Dublin, Ireland
- Department of Clinical Medicine, School of Medicine, Trinity College Dublin, D02 PN91 Dublin, Ireland
- Hospital Clinic, Institut D’Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Universidad de Barcelona, Ciberes, 08036 Barcelona, Spain
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15
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Whitney L, Armstrong‐James D, Lyster HS, Reed AK, Dunning J, Nwankwo L, Cheong J. Antifungal stewardship in solid‐organ transplantation: What is needed? Transpl Infect Dis 2022; 24:e13894. [DOI: 10.1111/tid.13894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 05/15/2022] [Indexed: 11/06/2022]
Affiliation(s)
| | | | - Haifa S. Lyster
- Department of Heart and Lung Transplantation The Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital Harefield Middlesex UK
| | - Anna K. Reed
- Department of Lung Transplantation Royal Brompton and Harefield National Health Service (NHS) Foundation Trust London UK
| | - John Dunning
- Department of Lung Transplantation Royal Brompton and Harefield National Health Service (NHS) Foundation Trust London UK
| | - Lisa Nwankwo
- Department of Pharmacy Royal Brompton & Harefield NHS Foundation Trust London UK
| | - Jamie Cheong
- Department of Pharmacy Royal Brompton & Harefield NHS Foundation Trust London UK
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16
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Xiao W, Du L, Cai L, Miao T, Mao B, Wen F, Gibson PG, Gong D, Zeng Y, Kang M, Du X, Qu J, Wang Y, Liu X, Feng R, Fu J. Existing tests vs. novel non-invasive assays for detection of invasive aspergillosis in patients with respiratory diseases. Chin Med J (Engl) 2022; 135:00029330-990000000-00075. [PMID: 35861304 PMCID: PMC9532040 DOI: 10.1097/cm9.0000000000002050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Although existing mycological tests (bronchoalveolar lavage [BAL] galactomannan [GM], serum GM, serum (1,3)-β-D-glucan [BDG], and fungal culture) are widely used for diagnosing invasive pulmonary aspergillosis (IPA) in non-hematological patients with respiratory diseases, their clinical utility in this large population is actually unclear. We aimed to resolve this clinical uncertainty by evaluating the diagnostic accuracy and utility of existing tests and explore the efficacy of novel sputum-based Aspergillus assays. METHODS Existing tests were assessed in a prospective and consecutive cohort of patients with respiratory diseases in West China Hospital between 2016 and 2019 while novel sputum assays (especially sputum GM and Aspergillus-specific lateral-flow device [LFD]) in a case-controlled subcohort. IPA was defined according to the modified European Organization for Research and Treatment of Cancer/Mycoses Study Group criteria. Sensitivity and specificity were computed for each test and receiver operating characteristic (ROC) curve analysis was performed. RESULTS The entire cohort included 3530 admissions (proven/probable IPA = 66, no IPA = 3464) and the subcohort included 127 admissions (proven/probable IPA = 38, no IPA = 89). Sensitivity of BAL GM (≥1.0 optical density index [ODI]: 86% [24/28]) was substantially higher than that of serum GM (≥0.5 ODI: 38% [39/102]) ( χ2 = 19.83, P < 0.001), serum BDG (≥70 pg/mL: 33% [31/95]) ( χ2 = 24.65, P < 0.001), and fungal culture (33% [84/253]) ( χ2 = 29.38, P < 0.001). Specificity varied between BAL GM (≥1.0 ODI: 94% [377/402]), serum GM (≥0.5 ODI: 95% [2130/2248]), BDG (89% [1878/2106]), and culture (98% [4936/5055]). Sputum GM (≥2.0 ODI) had similar sensitivity (84% [32/38]) (Fisher's exact P = 1.000) to and slightly lower specificity (87% [77/89]) ( χ2 = 5.52, P = 0.019) than BAL GM (≥1.0 ODI). Area under the ROC curve values were comparable between sputum GM (0.883 [0.812-0.953]) and BAL GM (0.901 [0.824-0.977]) ( P = 0.734). Sputum LFD had similar specificity (91% [81/89]) ( χ2 = 0.89, P = 0.345) to and lower sensitivity (63% [24/38]) ( χ2 = 4.14, P = 0.042) than BAL GM (≥1.0 ODI), but significantly higher sensitivity than serum GM (≥0.5 ODI) ( χ2 = 6.95, P = 0.008), BDG ( χ2 = 10.43, P = 0.001), and fungal culture ( χ2 = 12.70, P < 0.001). CONCLUSIONS Serum GM, serum BDG, and fungal culture lack sufficient sensitivity for diagnosing IPA in respiratory patients. Sputum GM and LFD assays hold promise as rapid, sensitive, and non-invasive alternatives to the BAL GM test.
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Affiliation(s)
- Wei Xiao
- Respiratory Group, Department of Integrated Traditional Chinese and Western Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China
- Divison of Pulmonary Diseases, State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan 610093, China
| | - Longyi Du
- West China School of Medicine, Sichuan University, Chengdu, Sichuan 610041, China
| | - Linli Cai
- Respiratory Group, Department of Integrated Traditional Chinese and Western Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China
| | - Tiwei Miao
- Respiratory Group, Department of Integrated Traditional Chinese and Western Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China
| | - Bing Mao
- Respiratory Group, Department of Integrated Traditional Chinese and Western Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China
| | - Fuqiang Wen
- Divison of Pulmonary Diseases, State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan 610093, China
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China
| | - Peter Gerard Gibson
- Priority Research Centre for Healthy Lungs, The University of Newcastle, Newcastle, NSW 2305, Australia
- Priority Research Centre for Asthma and Respiratory Diseases, Hunter Medical Research Institute, Newcastle, NSW 2305, Australia
- Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, NSW 2305, Australia
| | - Deying Gong
- Laboratory of Anesthesia and Critical Care Medicine, Translational Neuroscience Center, West China Hospital of Sichuan University, Chengdu, Sichuan 610093, China
| | - Yan Zeng
- Department of Pneumology, Pidu District of Traditional Chinese Medicine, The Third Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan 611730, China
| | - Mei Kang
- Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China
| | - Xinmiao Du
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China
| | - Junyan Qu
- Center of Infectious Disease, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China
| | - Yan Wang
- Research Core Facility, West China Hospital of Sichuan University, Chengdu, Sichuan 610093, China
| | - Xuemei Liu
- Respiratory Group, Department of Integrated Traditional Chinese and Western Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China
| | - Ruizhi Feng
- Respiratory Group, Department of Integrated Traditional Chinese and Western Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China
| | - Juanjuan Fu
- Respiratory Group, Department of Integrated Traditional Chinese and Western Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China
- Divison of Pulmonary Diseases, State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan 610093, China
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17
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Thompson GR, Boulware DR, Bahr NC, Clancy CJ, Harrison TS, Kauffman CA, Le T, Miceli MH, Mylonakis E, Nguyen MH, Ostrosky-Zeichner L, Patterson TF, Perfect JR, Spec A, Kontoyiannis DP, Pappas PG. Noninvasive Testing and Surrogate Markers in Invasive Fungal Diseases. Open Forum Infect Dis 2022; 9:ofac112. [PMID: 35611348 PMCID: PMC9124589 DOI: 10.1093/ofid/ofac112] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 03/02/2022] [Indexed: 02/04/2023] Open
Abstract
Invasive fungal infections continue to increase as at-risk populations expand. The high associated morbidity and mortality with fungal diseases mandate the continued investigation of novel antifungal agents and diagnostic strategies that include surrogate biomarkers. Biologic markers of disease are useful prognostic indicators during clinical care, and their use in place of traditional survival end points may allow for more rapid conduct of clinical trials requiring fewer participants, decreased trial expense, and limited need for long-term follow-up. A number of fungal biomarkers have been developed and extensively evaluated in prospective clinical trials and small series. We examine the evidence for these surrogate biomarkers in this review and provide recommendations for clinicians and regulatory authorities.
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Affiliation(s)
- George R Thompson
- Division of Infectious Diseases, Department of Internal Medicine, University of California-Davis Medical Center, Sacramento California, USA
- Department of Medical Microbiology and Immunology, University of California-Davis, Davis, California, USA
| | - David R Boulware
- Division of Infectious Diseases, Department of Internal Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Nathan C Bahr
- Division of Infectious Diseases, Department of Medicine, University of Kansas, Kansas City, Kansas, USA
| | - Cornelius J Clancy
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
| | - Thomas S Harrison
- Centre for Global Health, Institute of Infection and Immunity, St George’s University of London, London, United Kingdom
- Clinical Academic Group in Infection, St George’s Hospital NHS Trust, London, United Kingdom
- MRC Centre for Medical Mycology, University of Exeter, Exeter, United Kingdom
| | - Carol A Kauffman
- VA Ann Arbor Healthcare System and University of Michigan, Ann Arbor, Michigan, USA
| | - Thuy Le
- Division of Infectious Diseases and International Health, Duke University School of Medicine, Durham, North Carolina, USA
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | | | - Eleftherios Mylonakis
- Division of Infectious Diseases, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - M Hong Nguyen
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | | | - Thomas F Patterson
- Division of Infectious Diseases, Department of Medicine, The University of Texas Health Science Center, San Antonio, Texas, USA
| | - John R Perfect
- Division of Infectious Diseases and International Health, Duke University School of Medicine, Durham, North Carolina, USA
- Division of Infectious Diseases, Department of Molecular Genetics and Microbiology, Duke University, Durham, North Carolina, USA
| | - Andrej Spec
- Division of Infectious Diseases, Department of Medicine, Washington University in St. Louis, School of Medicine, St. Louis, Missouri, USA
| | - Dimitrios P Kontoyiannis
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Peter G Pappas
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
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18
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Fayed AE, Hamza II, Embabi SN. Unique presentations of aspergillosis endogenous endophthalmitis in two hospitalized patients with severe COVID-19. Indian J Ophthalmol 2022; 70:1421-1424. [PMID: 35326072 PMCID: PMC9240524 DOI: 10.4103/ijo.ijo_2718_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We present two ICU-hospitalized patients with coronavirus disease-19 (COVID-19) presenting with endogenous endophthalmitis in one eye and variable manifestations of chorioretinitis in the fellow eye. Two diabetic patients (57 and 62 years old) showed anterior uveitis and yellowish-white subretinal infiltrations. The fellow eye of one patient showed patches of choroiditis, while the other showed full retinal thickness infiltrations. A workup yielded high serum titers of galactomannan, diagnostic of aspergillosis. The widespread use of high doses of corticosteroids in the management of COVID-19 may predispose to various secondary fungal opportunistic infections and may manifest in different forms of chorioretinal infiltration.
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Affiliation(s)
- Alaa E Fayed
- Department of Ophthalmology, Kasr Al-Ainy School of Medicine, Cairo University, Giza; Watany Eye Hospital, Cairo, Egypt
| | - Ismail I Hamza
- Department of Ophthalmology, Faculty of Medicine, Ain Shams University, Cairo, India
| | - Sherif N Embabi
- Department of Ophthalmology, Faculty of Medicine, Ain Shams University; Watany Eye Hospital, Cairo, Egypt
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19
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Ceesay MM, Mehra V, Pagliuca A. Aspergillus Infections. N Engl J Med 2022; 386:198-199. [PMID: 35021000 DOI: 10.1056/nejmc2117819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
| | - Varun Mehra
- King's College Hospital, London, United Kingdom
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20
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The Alteration of Serum Galactomannan Levels in Surgically Treated Patients with Aspergilloma: a Prospective Observational Study. Indian J Surg 2021. [DOI: 10.1007/s12262-021-03150-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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21
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Li ZT, Zeng PY, Chen ZM, Guan WJ, Wang T, Lin Y, Li SQ, Zhang ZJ, Zhan YQ, Wang MD, Tan GB, Li X, Ye F. Exhaled Volatile Organic Compounds for Identifying Patients With Chronic Pulmonary Aspergillosis. Front Med (Lausanne) 2021; 8:720119. [PMID: 34631744 PMCID: PMC8495266 DOI: 10.3389/fmed.2021.720119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 08/31/2021] [Indexed: 12/20/2022] Open
Abstract
Background: Diagnosing chronic pulmonary aspergillosis is a major challenge in clinical practice. The development and validation of a novel, sensitive and specific assay for diagnosing chronic pulmonary aspergillosis is urgently needed. Methods: From April 2018 to June 2019, 53 patients with chronic pulmonary aspergillosis (CPA), 32 patients with community-acquired pneumonia (CAP) and 48 healthy controls were recruited from the First Affiliated Hospital of Guangzhou Medical University. Clinical characteristics and samples were collected at enrollment. All exhaled breath samples were analyzed offline using thermal desorption single-photon ionization time-of-flight mass spectrometry; to analyze the metabolic pathways of the characteristic volatile organic compounds, serum samples were subjected to ultrahigh-performance liquid chromatography. Results: We identified characteristic volatile organic compounds in patients with chronic pulmonary aspergillosis, which mainly consisted of phenol, neopentyl alcohol, toluene, limonene and ethylbenzene. These compounds were assessed using a logistic regression model. The sensitivity and specificity were 95.8 and 96.9% for discriminating patients in the CPA group from those in the CAP group and 95.8 and 97.9% for discriminating patients in the CPA group from healthy controls, respectively. The concentration of limonene (m/z 136) correlated significantly positively with anti-Aspergillus fumigatus IgG antibody titers (r = 0.420, P < 0.01). After antifungal treatment, serum IgG and the concentration of limonene (m/z 136) decreased in the subgroup of patients with chronic pulmonary aspergillosis. Conclusions: We identified VOCs that can be used as biomarkers for differential diagnosis and therapeutic response prediction in patients with chronic pulmonary aspergillosis.
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Affiliation(s)
- Zheng-Tu Li
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Pei-Ying Zeng
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhao-Ming Chen
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wei-Jie Guan
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Department of Thoracic Surgery, Guangzhou Institute for Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Tong Wang
- Institute of Mass Spectrometry and Atmospheric Environment, Jinan University, Guangzhou, China.,Guangdong Provincial Engineering Research Center for On-Line Source Apportionment System of Air Pollution, Guangzhou, China
| | - Ye Lin
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Shao-Qiang Li
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhi-Juan Zhang
- Institute of Mass Spectrometry and Atmospheric Environment, Jinan University, Guangzhou, China.,Guangdong Provincial Engineering Research Center for On-Line Source Apportionment System of Air Pollution, Guangzhou, China.,College of Pharmacy, Hena University of Chinese Medicine, Zhengzhou, China
| | - Yang-Qing Zhan
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Ming-Die Wang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Guo-Bin Tan
- Institute of Mass Spectrometry and Atmospheric Environment, Jinan University, Guangzhou, China.,Guangdong Provincial Engineering Research Center for On-Line Source Apportionment System of Air Pollution, Guangzhou, China.,Guangzhou Hexin Instrument Co., Ltd., Guangzhou, China
| | - Xue Li
- Institute of Mass Spectrometry and Atmospheric Environment, Jinan University, Guangzhou, China.,Guangdong Provincial Engineering Research Center for On-Line Source Apportionment System of Air Pollution, Guangzhou, China
| | - Feng Ye
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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22
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Development of a Method of Measuring β-D-Glucan and Its Use in Preemptive Therapy for Invasive Fungal Infections. Int J Mol Sci 2021; 22:ijms22179265. [PMID: 34502174 PMCID: PMC8431658 DOI: 10.3390/ijms22179265] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 08/23/2021] [Accepted: 08/24/2021] [Indexed: 12/28/2022] Open
Abstract
Invasive fungal infections (IFIs) are serious infections that develop in conjunction with neutropenia after chemotherapy for acute leukemia or with hematopoietic stem cell transplantation. Conventionally, empirical antifungal therapy was recommended to treat IFIs for patient safety despite a lack of evidence of fungal infections. However, many studies have indicated that antifungals were not necessary for over half of patients, and several detriments of empirical therapy were noted, e.g., antifungals caused adverse reactions, an increase in drug-resistant fungi was a possibility, and medical costs soared. β-D-glucan (BDG) is a component of clinically important fungi such as Aspergillus and Candida. The G-test was developed in Japan as a way to measure BDG in serum using a coagulation factor from the blood of the horseshoe crab. Pre-emptive antifungal therapy based upon serodiagnosis with a BDG or galactomannan assay and CT imaging has been introduced. With pre-emptive antifungal therapy, the prognosis is equivalent to that with empirical therapy, and the dose of the antifungal has been successfully reduced. Measurement of BDG has been adopted widely as a method of diagnosing IFIs and is listed in the key guidelines for fungal infections and febrile neutropenia.
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23
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Challenges with Utilizing the 1,3-Beta-d-Glucan and Galactomannan Assays To Diagnose Invasive Mold Infections in Immunocompromised Children. J Clin Microbiol 2021; 59:e0327620. [PMID: 33883182 DOI: 10.1128/jcm.03276-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Establishing the diagnosis of invasive mold infections (IMI) in immunocompromised children is challenging due to nonspecific clinical presentations and the limited sensitivity of traditional culture-based methods. Rapid non-culture-based diagnostics such as the 1,3-beta-d-glucan and galactomannan assays have emerged as promising adjuncts to conventional diagnostic tests in adults. Available data suggest that 1,3-beta-d-glucan has limited accuracy in the pediatric population and is not recommended to be used for the diagnosis of IMI in children. On the other hand, the diagnostic performance of the serum and bronchoalveolar lavage galactomannan in immunocompromised children is comparable to results observed in adults and can be used as a screening tool in children at high risk of developing invasive aspergillosis (IA) who are not receiving mold-active antifungal prophylaxis and as a diagnostic tool in symptomatic children suspected of having IA. Herein, we summarize the available evidence for the use of these rapid non-culture-based diagnostics in immunocompromised children. We also summarize potential causes of false positivity for the 1,3-beta-d-glucan and galactomannan assays.
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24
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Navarosh J, Pushker N, Xess I, Singh L, Bajaj MS, Kashyap S, Thakar A. Correlation of serum galactomannan antigen with diagnosis and response to voriconazole in orbital/sino-orbital invasive aspergillosis. Int Ophthalmol 2021; 41:2635-2638. [PMID: 34110546 DOI: 10.1007/s10792-021-01848-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 04/08/2021] [Indexed: 11/25/2022]
Affiliation(s)
- J Navarosh
- Oculoplasty and Pediatric Ophthalmology Services, Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, 110 029, India
| | - N Pushker
- Oculoplasty and Pediatric Ophthalmology Services, Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, 110 029, India.
| | - I Xess
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, 110 029, India
| | - L Singh
- Ocular Pathology, Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, 110 029, India
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110 029, India
| | - M S Bajaj
- Oculoplasty and Pediatric Ophthalmology Services, Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, 110 029, India
| | - S Kashyap
- Ocular Pathology, Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, 110 029, India
| | - A Thakar
- Department of ENT, All India Institute of Medical Sciences, New Delhi, 110 029, India
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25
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Wuniqiemu T, Nabijan M, Cui J, Teng F, Lv Z, Wei Y, Dong J. Serum galactomannan level for the diagnosis of invasive pulmonary aspergillosis in hospitalized patients with chronic obstructive pulmonary disease (COPD): Meta-analysis. TRADITIONAL MEDICINE AND MODERN MEDICINE 2021. [DOI: 10.1142/s2575900020300027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: The serum galactomannan (GM) assay is used to diagnose invasive pulmonary aspergillosis (IPA). We conducted a meta-analysis to assess the overall accuracy of the serum GM test for detecting IPA in critically ill COPD patients. Methods: The web of science, Pubmed, Embase, China National Knowledge Infrastructure, WanFang, Weipu (VIP) Science China databases were searched for all the eligible studies, including randomized controlled trials and prospective studies up to February 2019. We selected and assessed articles that reported diagnostic data related to serum GM for diagnosis of invasive fungal disease in hospitalized COPD patients. Additionally, pooled sensitivity (SEN), specificity (SPE), true positive (TP), false positive (FP), true negative (TN), false negative (FN) were estimated for summarizing overall test performance. Results: Of 1104 articles screened, 14 studies were involved in the meta-analysis with 1127 patients in the COPD serum sample. The pooled serum GM assay results with cutoff value of 0.5 were as follows: DOR: 15 (95% CI, 6–38), sensitivity: 0.57 (95% CI, 0.37–0.75), specificity: 0.92 (95%,CI, 0.85–0.96), and the SROC was 0.89 (95% CI, 0.86–0.91). When the cutoff value was 1, the results were as follows: DOR: 33 (95% CI, 15–70), sensitivity: 0.57 (95% CI, 0.39–0.73), specificity: 0.96 (95% CI, 0.93–0.98), and SROC was 0.95 (95% CI, 0.92–0.96). Conclusion: Serum GM can be used to assist in diagnosis of IPA in critically ill COPD patients. When cutoff value was set as 1, serum GM had better diagnostic value compared to those with cutoff of 0.5.
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Affiliation(s)
- Tulake Wuniqiemu
- Department of Integrative Medicine, Huashan Hospital of Fudan University, Shanghai, P. R. China
| | - Mohammadtursun Nabijan
- Department of Integrative Medicine, Huashan Hospital of Fudan University, Shanghai, P. R. China
- Institutes of Integrative Medicine, Fudan University, Shanghai, P. R. China
| | - Jie Cui
- Department of Integrative Medicine, Huashan Hospital of Fudan University, Shanghai, P. R. China
- Institutes of Integrative Medicine, Fudan University, Shanghai, P. R. China
| | - Fangzhou Teng
- Department of Integrative Medicine, Huashan Hospital of Fudan University, Shanghai, P. R. China
- Institutes of Integrative Medicine, Fudan University, Shanghai, P. R. China
| | - Zexi Lv
- Department of Integrative Medicine, Huashan Hospital of Fudan University, Shanghai, P. R. China
- Institutes of Integrative Medicine, Fudan University, Shanghai, P. R. China
| | - Ying Wei
- Department of Integrative Medicine, Huashan Hospital of Fudan University, Shanghai, P. R. China
- Institutes of Integrative Medicine, Fudan University, Shanghai, P. R. China
| | - Jingcheng Dong
- Department of Integrative Medicine, Huashan Hospital of Fudan University, Shanghai, P. R. China
- Institutes of Integrative Medicine, Fudan University, Shanghai, P. R. China
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26
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Patel D, Dacanay KC, Pashley CH, Gaillard EA. Comparative Analysis of Clinical Parameters and Sputum Biomarkers in Establishing the Relevance of Filamentous Fungi in Cystic Fibrosis. Front Cell Infect Microbiol 2021; 10:605241. [PMID: 33553007 PMCID: PMC7862329 DOI: 10.3389/fcimb.2020.605241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 12/04/2020] [Indexed: 11/13/2022] Open
Abstract
Background The relationship between fungal culture (FC) positivity and airway inflammation in CF is largely unknown. Identifying the clinical significance of filamentous fungi in CF using both clinical parameters and biomarkers may change our antimicrobial therapeutic strategies. Objectives To investigate the clinical characteristics and airway biomarker profile in relation to the detection of filamentous fungi in respiratory samples obtained from CF patients. Methods A prospective cohort study over 24 months, including children and adults with CF. Participants provided sputum and/or bronchoalveolar lavage samples, which underwent processing for bacterial and fungal culture, leukocyte differential cell count and biomarker analysis for neutrophil elastase (NE), interleukin-8 (IL-8), galactomannan and tumor necrosis factor receptor type 2 (TNF-R2). We performed FC using neat sputum plugs, an approach shown to be more sensitive compared to routine laboratory testing. Results Sixty-one patients provided 76 respiratory samples (72 sputum and 4 BAL). Median age was 17 years (range 6 months-59 years). FC positivity was noted in 49% of the cohort. FC positivity was greater during pulmonary exacerbation compared to the stable state (67 versus 50%). Participants aged 5-30 years had a lower FEV1 within the FC positive group. A significant association between FC positivity and non-tuberculosis mycobacterial (NTM) culture was observed on non-parametric testing (p = 0.022) and regression analysis (p = 0.007). Exposure to indoor mold was a predictor for FC positivity (p = 0.047). There was a trend towards increased lung clearance index (LCI), bronchiectasis and intravenous antibiotic use in the FC positive group. There was no significant difference in biomarkers between FC positive and negative patients. Conclusion Aspergillus. fumigatus is the commonest filamentous fungi cultured from CF airways. We found no difference in the airway biomarker profile between FC positive and negative patients. The role of galactomannan and TNFR2 as fungal specific biomarkers in CF remains uncertain. FC positivity is associated with a lower FEV1 in younger patients, a lower LCI, NTM positivity, bronchiectasis, and intravenous antibiotic exposure. Larger trials are needed to determine the role of galactomannan and TNF-R2 as potential fungal biomarkers in CF.
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Affiliation(s)
- Deepa Patel
- Department of Respiratory Sciences, University of Leicester, Leicester, United Kingdom.,Paediatric Respiratory Department, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Keith Chester Dacanay
- Department of Respiratory Sciences, University of Leicester, Leicester, United Kingdom.,Institute for Lung Health, NIHR Respiratory Biomedical Research Center, Leicester, United Kingdom
| | - Catherine H Pashley
- Department of Respiratory Sciences, University of Leicester, Leicester, United Kingdom.,Institute for Lung Health, NIHR Respiratory Biomedical Research Center, Leicester, United Kingdom
| | - Erol A Gaillard
- Department of Respiratory Sciences, University of Leicester, Leicester, United Kingdom.,Paediatric Respiratory Department, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom.,Institute for Lung Health, NIHR Respiratory Biomedical Research Center, Leicester, United Kingdom
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27
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Association of Fungal Siderophores in Human Diseases: Roles and Treatments. Fungal Biol 2021. [DOI: 10.1007/978-3-030-53077-8_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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28
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Wang S, Yuan A, Zeng L, Hou S, Wang M, Li L, Cai Z, Zhong G. The putative polysaccharide synthase AfCps1 regulates Aspergillus fumigatus morphogenesis and conidia immune response in mouse bone marrow-derived macrophages. J Microbiol 2020; 59:64-75. [PMID: 33201436 DOI: 10.1007/s12275-021-0347-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 10/13/2020] [Accepted: 10/13/2020] [Indexed: 10/23/2022]
Abstract
Aspergillus fumigatus is a well-known opportunistic pathogen that causes invasive aspergillosis (IA) infections with high mortality in immunosuppressed individuals. Morphogenesis, including hyphal growth, conidiation, and cell wall biosynthesis is crucial in A. fumigatus pathogenesis. Based on a previous random insertional mutagenesis library, we identified the putative polysaccharide synthase gene Afcps1 and its para-log Afcps2. Homologs of the cps gene are commonly found in the genomes of most fungal and some bacterial pathogens. Afcps1/cpsA is important in sporulation, cell wall composition, and virulence. However, the precise regulation patterns of cell wall integrity by Afcps1/cpsA and further effects on the immune response are poorly understood. Specifically, our in-depth study revealed that Afcps1 affects cell-wall stability, showing an increased resistance of ΔAfcps1 to the chitinmicrofibril destabilizing compound calcofluor white (CFW) and susceptibility of ΔAfcps1 to the β-(1,3)-glucan synthase inhibitor echinocandin caspofungin (CS). Additionally, deletion of Afcps2 had a normal sporulation phenotype but caused hypersensitivity to Na+ stress, CFW, and Congo red (CR). Specifically, quantitative analysis of cell wall composition using high-performance anion exchange chromatography-pulsed amperometric detector (HPAEC-PAD) analysis revealed that depletion of Afcps1 reduced cell wall glucan and chitin contents, which was consistent with the down-regulation of expression of the corresponding biosynthesis genes. Moreover, an elevated immune response stimulated by conidia of the ΔAfcps1 mutant in marrow-derived macrophages (BMMs) during phagocytosis was observed. Thus, our study provided new insights into the function of polysaccharide synthase Cps1, which is necessary for the maintenance of cell wall stability and the adaptation of conidia to the immune response of macrophages in A. fumigatus.
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Affiliation(s)
- Sha Wang
- Key Laboratory of Vector Biology and Pathogen Control of Zhejiang Province, Huzhou University, Huzhou Central Hospital, Huzhou, P. R. China
| | - Anjie Yuan
- Center for Global Health, School of Public Health, Nanjing Medical University, 101 Longmian Avenue, Nanjing, 211166, P. R. China
| | - Liping Zeng
- Center for Global Health, School of Public Health, Nanjing Medical University, 101 Longmian Avenue, Nanjing, 211166, P. R. China
| | - Sikai Hou
- Center for Global Health, School of Public Health, Nanjing Medical University, 101 Longmian Avenue, Nanjing, 211166, P. R. China
| | - Meng Wang
- Center for Global Health, School of Public Health, Nanjing Medical University, 101 Longmian Avenue, Nanjing, 211166, P. R. China
| | - Lei Li
- Center for Global Health, School of Public Health, Nanjing Medical University, 101 Longmian Avenue, Nanjing, 211166, P. R. China
| | - Zhendong Cai
- Key Laboratory of Animal Protein Deep Processing Technology of Zhejiang Province, College of Food and Pharmaceutical Sciences, Ningbo University, Ningbo, 315800, P. R. China.
| | - Guowei Zhong
- Center for Global Health, School of Public Health, Nanjing Medical University, 101 Longmian Avenue, Nanjing, 211166, P. R. China.
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29
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Weinbergerova B, Kabut T, Kocmanova I, Lengerova M, Pospisil Z, Kral Z, Mayer J. Bronchoalveolar lavage fluid and serum 1,3-β-D-glucan testing for invasive pulmonary aspergillosis diagnosis in hematological patients: the role of factors affecting assay performance. Sci Rep 2020; 10:17963. [PMID: 33087853 PMCID: PMC7578802 DOI: 10.1038/s41598-020-75132-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 10/08/2020] [Indexed: 02/06/2023] Open
Abstract
Invasive fungal disease (IFD) early diagnosis improves hematological patient survival. Non-culture-based methods may reduce diagnostic time to identify IFD. As complex data on the value of 1,3-β-D-glucan (BDG) from bronchoalveolar lavage fluid (BALF) compared to serum for the most frequent invasive pulmonary aspergillosis (IPA) diagnosis are scarce, particularly including evaluation of potential factors adversely affecting BDG assay, we provided prospective single-center analysis evaluating 172 episodes of pulmonary infiltrates with BDG detection in BALF and serum samples collected in parallel among hematological patients from 2006 to 2015. Proven and probable IPA were documented in 13.4% of the episodes. Sensitivity (SEN), specificity (SPE), positive and negative predictive value (PPV; NPV), and diagnostic odds ratio (DOR) of the BDG assay using standard (80 pg/ml) cut-off for BALF were: 56.5%; 83.2%; 34.2%; 92.5%, and 6.5, respectively, and for serum were: 56.5%; 82.6%; 33.3%; 92.5%, and 6.2, respectively. The same BDG assay parameters employing a calculated optimal cut-off for BALF (39 pg/ml) were: 78.3%; 72.5%; 30.5%; 95.6%, and 9.5, respectively; and for serum (40 pg/ml) were: 73.9%; 69.1%; 27.0%; 94.5%, and 6.3, respectively. While identifying acceptable SEN, SPE, and DOR, yet low PPV of both BALF and serum BDG assay for IPA diagnosis, neither the combination of both materials nor the new optimal BDG cut-off led to significant test quality improvement. Absolute neutrophil count and aspirated BALF volume with a significant trend affected BDG assay performance. The BDG test did not outperform galactomannan assay.
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Affiliation(s)
- Barbora Weinbergerova
- Department of Internal Medicine-Hematology and Oncology, Masaryk University and University Hospital, Brno, Czech Republic.
| | - Tomas Kabut
- Department of Internal Medicine-Hematology and Oncology, Masaryk University and University Hospital, Brno, Czech Republic
| | - Iva Kocmanova
- Department of Clinical Microbiology, University Hospital, Brno, Czech Republic
| | - Martina Lengerova
- Department of Internal Medicine-Hematology and Oncology, Masaryk University and University Hospital, Brno, Czech Republic.,CEITEC - Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - Zdenek Pospisil
- Department of Mathematics and Statistics, Faculty of Science, Masaryk University, Brno, Czech Republic
| | - Zdenek Kral
- Department of Internal Medicine-Hematology and Oncology, Masaryk University and University Hospital, Brno, Czech Republic.,CEITEC - Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - Jiri Mayer
- Department of Internal Medicine-Hematology and Oncology, Masaryk University and University Hospital, Brno, Czech Republic.,CEITEC - Central European Institute of Technology, Masaryk University, Brno, Czech Republic
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30
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Waqas S, Dunne K, Talento AF, Wilson G, Martin-Loeches I, Keane J, Rogers TR. Prospective observational study of respiratory Aspergillus colonization or disease in patients with various stages of chronic obstructive pulmonary disease utilizing culture versus nonculture techniques. Med Mycol 2020; 59:myaa077. [PMID: 32926151 DOI: 10.1093/mmy/myaa077] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/28/2020] [Accepted: 08/13/2020] [Indexed: 12/11/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) patients have been recognized to be at increased risk of Aspergillus spp. colonization, which may progress to invasive pulmonary aspergillosis (IPA). The objective of this study was to determine the frequency of Aspergillus colonization, or disease, in a cohort of COPD patients. A prospective observational study was undertaken to determine Aspergillus colonization, or disease, in consecutive COPD patients undergoing bronchoscopy. Fungal culture as well as galactomannan antigen (GM) and Aspergillus nucleic acid detection (PCR) were performed on bronchoalveolar lavage fluid (BAL) samples. One hundred and fifty patients were recruited. One hundred and twelve (74.7%) were outpatients, 38 (25.33%) were inpatients, of whom 6 (4%) were in the intensive care unit. Most patients (N = 122, 81.3%) were either COPD GOLD (Global Initiative for Chronic Obstructive Lung Disease) stages 1 or 2. Nine (6%) patients were on systemic steroids, 64 (42.7%) on inhaled steroids, and 9 (6%) on both. Seventeen patients (11.3%) had at least one positive test for Aspergillus detection (culture ± galactomannan ± polymerase chain reaction [PCR]), 13 (76.4%) of whom were COPD GOLD stages 1 or 2. Five patients had probable or putative IPA. Aspergillus sp. was detected in five patients (3.3%) by culture, but detection increased to 17 (11.3%) by the additional testing for GM or Aspergillus DNA. The frequency of Aspergillus detection in this cohort of COPD patients may reflect the predominance of early GOLD stages among the study population but deserves further investigation to determine its relevance as a predictive risk factor for IPA. LAY SUMMARY COPD is a risk factor for Aspergillus spp. colonization. Bronchoalveolar lavage samples of 150 COPD patients were tested for presence of Aspergillus fumigatus, which was detected in five patients (3.3%) by culture, but detection of Aspergillus increased to 17 (11.3%) by additional GM and PCR testing.
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Affiliation(s)
- Sarmad Waqas
- Department of Clinical Medicine, Trinity College Dublin, Ireland
| | - Katie Dunne
- Department of Clinical Microbiology, Trinity College Dublin, Ireland
| | - Alida Fe Talento
- Department of Clinical Microbiology, Trinity College Dublin, Ireland
- Department of Microbiology, St. James's Hospital, Dublin 8, Ireland
| | - Graham Wilson
- Department of Radiology, St. James's Hospital, Dublin 8, Ireland
| | - Ignacio Martin-Loeches
- Department of Clinical Medicine, Trinity College Dublin, Ireland
- Department of Intensive Care Medicine, St. James's Hospital, Dublin 8, Ireland
| | - Joseph Keane
- Department of Clinical Medicine, Trinity College Dublin, Ireland
- Department of Respiratory Medicine, St. James's Hospital, Dublin 8, Ireland
| | - Thomas R Rogers
- Department of Clinical Microbiology, Trinity College Dublin, Ireland
- Department of Microbiology, St. James's Hospital, Dublin 8, Ireland
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Li X, Zheng Y, Wu F, Mo D, Liang G, Yan R, Khader JA, Wu N, Cao C. Evaluation of quantitative real-time PCR and Platelia galactomannan assays for the diagnosis of disseminated Talaromyces marneffei infection. Med Mycol 2020; 58:181-186. [PMID: 31131856 DOI: 10.1093/mmy/myz052] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 04/16/2019] [Accepted: 05/07/2019] [Indexed: 11/12/2022] Open
Abstract
Talaromyces (Penicillium) marneffei is an emerging pathogen that causes significant morbidity and mortality in immunocompromised patients in endemic regions such as southeast Asia. The diagnosis of disseminated T. marneffei infection remains challenging in clinical practice. In the study, a well-validated real-time quantitative polymerase chain reaction (qPCR) target region of ITS1-5.8S-ITS2 and a Platelia galactomannan (GM) assay were compared for their diagnostic performance using serum samples from patients with or without human immunodeficiency virus (HIV). The results showed that this novel qPCR method is highly sensitive and specific for T. marneffei DNA detection in serum samples, and the limit of detection and species-specificity of qPCR were five copies of DNA and 100%, respectively. For detection in serum samples from 36 talaromycosis patients, the sensitivity of qPCR was 86.11% (31/36), including 20/20 (100%) patients with fungemia and 11/16 (68.75%) patients without fungemia. For the GM assay, the sensitivity was 80.56% (29/36) when the GM optical density cutoff index was ≥0.5, including 19/20 (95%) patients with fungemia and 10/16 (62.5%) patients without fungemia. These results indicate that the novel qPCR and GM assays can be used as a valuable tool in the diagnosis of T. marneffei infection. Serum samples are convenient hematological specimens for T. marneffei DNA quantification. Combining the GM assay and qPCR is more scientific and appropriate for diagnosing T. marneffei infection in endemic areas.
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Affiliation(s)
- Xinlei Li
- Department of Dermatology and Venereology, the First Affiliated Hospital of Guangxi Medical University, Nanning, P. R. China.,Department of Mycology, Yulin Hospital of Dermatology, Yulin, P. R. China
| | - Yanqing Zheng
- Department of Dermatology and Venereology, the First Affiliated Hospital of Guangxi Medical University, Nanning, P. R. China.,HIV/AIDS Clinical Treatment Center of Guangxi, The Fourth People's Hospital of Nanning, Nanning, P. R. China
| | - Fengyao Wu
- HIV/AIDS Clinical Treatment Center of Guangxi, The Fourth People's Hospital of Nanning, Nanning, P. R. China
| | - Dongdong Mo
- Department of Dermatology and Venereology, the First Affiliated Hospital of Guangxi Medical University, Nanning, P. R. China
| | - Gang Liang
- School of Preclinical Medicine of Guangxi Medical University, Nanning, P. R. China
| | - Rufan Yan
- Department of Dermatology and Venereology, the First Affiliated Hospital of Guangxi Medical University, Nanning, P. R. China.,Guangxi Key Laboratory of AIDS Prevention and Treatment, Guangxi Medical University, Nanning, P. R. China
| | - Jazeer Abdul Khader
- Department of Dermatology and Venereology, the First Affiliated Hospital of Guangxi Medical University, Nanning, P. R. China.,Guangxi Key Laboratory of AIDS Prevention and Treatment, Guangxi Medical University, Nanning, P. R. China
| | - Nianning Wu
- HIV/AIDS Clinical Treatment Center of Guangxi, The Fourth People's Hospital of Nanning, Nanning, P. R. China
| | - Cunwei Cao
- Department of Dermatology and Venereology, the First Affiliated Hospital of Guangxi Medical University, Nanning, P. R. China
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32
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Donnelly JP, Chen SC, Kauffman CA, Steinbach WJ, Baddley JW, Verweij PE, Clancy CJ, Wingard JR, Lockhart SR, Groll AH, Sorrell TC, Bassetti M, Akan H, Alexander BD, Andes D, Azoulay E, Bialek R, Bradsher RW, Bretagne S, Calandra T, Caliendo AM, Castagnola E, Cruciani M, Cuenca-Estrella M, Decker CF, Desai SR, Fisher B, Harrison T, Heussel CP, Jensen HE, Kibbler CC, Kontoyiannis DP, Kullberg BJ, Lagrou K, Lamoth F, Lehrnbecher T, Loeffler J, Lortholary O, Maertens J, Marchetti O, Marr KA, Masur H, Meis JF, Morrisey CO, Nucci M, Ostrosky-Zeichner L, Pagano L, Patterson TF, Perfect JR, Racil Z, Roilides E, Ruhnke M, Prokop CS, Shoham S, Slavin MA, Stevens DA, Thompson GR, Vazquez JA, Viscoli C, Walsh TJ, Warris A, Wheat LJ, White PL, Zaoutis TE, Pappas PG. Revision and Update of the Consensus Definitions of Invasive Fungal Disease From the European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium. Clin Infect Dis 2020; 71:1367-1376. [PMID: 31802125 PMCID: PMC7486838 DOI: 10.1093/cid/ciz1008] [Citation(s) in RCA: 1450] [Impact Index Per Article: 362.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 10/08/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Invasive fungal diseases (IFDs) remain important causes of morbidity and mortality. The consensus definitions of the Infectious Diseases Group of the European Organization for Research and Treatment of Cancer and the Mycoses Study Group have been of immense value to researchers who conduct clinical trials of antifungals, assess diagnostic tests, and undertake epidemiologic studies. However, their utility has not extended beyond patients with cancer or recipients of stem cell or solid organ transplants. With newer diagnostic techniques available, it was clear that an update of these definitions was essential. METHODS To achieve this, 10 working groups looked closely at imaging, laboratory diagnosis, and special populations at risk of IFD. A final version of the manuscript was agreed upon after the groups' findings were presented at a scientific symposium and after a 3-month period for public comment. There were several rounds of discussion before a final version of the manuscript was approved. RESULTS There is no change in the classifications of "proven," "probable," and "possible" IFD, although the definition of "probable" has been expanded and the scope of the category "possible" has been diminished. The category of proven IFD can apply to any patient, regardless of whether the patient is immunocompromised. The probable and possible categories are proposed for immunocompromised patients only, except for endemic mycoses. CONCLUSIONS These updated definitions of IFDs should prove applicable in clinical, diagnostic, and epidemiologic research of a broader range of patients at high-risk.
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Affiliation(s)
| | - Sharon C Chen
- Centre for Infectious Diseases and Microbiology, Laboratory Services, Institute of Clinical Pathology and Medical Research, Westmead Hospital, University of Sydney, Sydney, Australia
| | - Carol A Kauffman
- Division of Infectious Diseases, University of Michigan, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - William J Steinbach
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina, USA
| | - John W Baddley
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Paul E Verweij
- Center of Expertise in Mycology Radboudumc/CWZ, Nijmegen, The Netherlands
| | | | - John R Wingard
- Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Shawn R Lockhart
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Andreas H Groll
- Infectious Disease Research Program, Center for Bone Marrow Transplantation and Department of Pediatric Hematology and Oncology University Children’s Hospital, Münster, Germany
| | - Tania C Sorrell
- University of Sydney, Marie Bashir Institute for Infectious Diseases & Biosecurity, University of Sydney School of Medicine Faculty of Medicine and Health, Westmead Institute for Centre for Infectious Diseases and Microbiology, Western Sydney Local Health District, Sydney, Australia
| | - Matteo Bassetti
- Infectious Disease Clinic, Department of Medicine University of Udine and Department of Health Sciences, DISSAL, University of Genoa, Genoa, Italy
| | - Hamdi Akan
- Ankara University, Faculty of Medicine, Cebeci Campus, Hematology Clinical Research Unit, Ankara, Turkey
| | - Barbara D Alexander
- Department of Medicine and Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA
| | - David Andes
- Division of Infectious Diseases, Departments of Medicine, Microbiology and Immunology School of Medicine and Public Health and School of Pharmacy, University of Wisconsin, Madison, Wisconsin, USA
| | - Elie Azoulay
- Médicine Intensive et Réanimation Hôpital Saint-Louis, APHP, Université Paris Diderot, Paris, France
| | - Ralf Bialek
- Molecular Diagnostics of Infectious Diseases, Microbiology, LADR Zentrallabor Dr. Kramer & Kollegen, Geesthacht, Germany
| | - Robert W Bradsher
- Division of Infectious Diseases, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Stephane Bretagne
- Institut Pasteur, Molecular Mycology Unit, CNRS UMR2000, Mycology Laboratory, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Thierry Calandra
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Angela M Caliendo
- Department of Medicine, Alpert Warren Medical School of Brown University, Providence, Rhode Island, USA
| | - Elio Castagnola
- Infectious Diseases Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Mario Cruciani
- Infectious Diseases Unit, G. Fracastoro Hospital, San Bonifacio, Verona, Italy
| | | | - Catherine F Decker
- Infectious Diseases Division, Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Sujal R Desai
- National Heart & Lung Institute, Imperial College London, the Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Brian Fisher
- Pediatric Infectious Diseases Division at the Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Thomas Harrison
- Centre for Global Health, Institute for Infection and Immunity, St Georges University of London, London, UK
| | - Claus Peter Heussel
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Translational Lung Research Center and Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik Heidelberg, Heidelberg, Germany
| | - Henrik E Jensen
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Bart-Jan Kullberg
- Radboud Center for Infectious Diseases and Department of Medicine, Radboudumc, Nijmegen, The Netherlands
| | - Katrien Lagrou
- Department of Microbiology, Immunology and Transplantation and Department of Laboratory Medicine and National Reference Centre for Mycosis, University Hospitals Leuven, Leuven, Belgium
| | - Frédéric Lamoth
- Infectious Diseases Service, Department of Medicine and Institute of Microbiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Thomas Lehrnbecher
- Pediatric Hematology and Oncology, Hospital for Children and Adolescents, University of Frankfurt, Frankfurt, Germany
| | - Jurgen Loeffler
- Molecular Biology and Infection, Medical Hospital II, WÜ4i, University Hospital Würzburg, Würzburg, Germany
| | - Olivier Lortholary
- Paris University, Necker Pasteur Center for Infectious Diseases and Tropical Medicine, IHU Imagine & Institut Pasteur, Molecular Mycology Unit, CNRS UMR 2000, Paris, France
| | - Johan Maertens
- Department of Hematology, University Hospitals Leuven, Leuven, Belgium
- Department of Microbiology, Immunology and Transplantation, K.U. Leuven, Leuven, Belgium
| | - Oscar Marchetti
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Kieren A Marr
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School
| | - Henry Masur
- Critical Care Medicine Department NIH-Clinical Center, Bethesda, Maryland, USA
| | - Jacques F Meis
- Department of Medical Microbiology and Infectious Diseases and Centre of Expertise in Mycology Radboudumc/Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | | | - Marcio Nucci
- Department of Internal Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Livio Pagano
- Istituto di Ematologia, Università Cattolica S. Cuore, Rome, Italy
| | - Thomas F Patterson
- UT Health San Antonio and South Texas Veterans Health Care System, San Antonio, Texas, USA
| | - John R Perfect
- Department of Medicine and Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA
| | - Zdenek Racil
- Department of Internal Medicine–Hematology and Oncology, Masaryk University and University Hospital Brno, Brno, Czech Republic
| | - Emmanuel Roilides
- Infectious Diseases Unit, 3rd Department of Pediatrics, Faculty of Medicine, Aristotle University School of Health Sciences, Hippokration General Hospital, Thessaloniki, Greece
| | - Marcus Ruhnke
- Department of Hematology & Oncology, Lukas Hospital, Buende, Germany
| | - Cornelia Schaefer Prokop
- Meander Medical Center Amersfoort and Radiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Shmuel Shoham
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School
| | - Monica A Slavin
- Department of Infectious Diseases, Peter MacCallum Cancer Center and the National Centre for Infections in Cancer, The University of Melbourne, Melbourne, Victoria, Australia
| | - David A Stevens
- Division of Infectious Diseases and Geographic Medicine, Stanford University Medical School, Stanford, California
- California Institute for Medical Research, San Jose, California, USA
| | - George R Thompson
- Department of Internal Medicine, Division of Infectious Diseases, University of California Davis Medical Center, Sacramento, California, USA
| | - Jose A Vazquez
- Division of Infectious Diseases, Medical College of Georgia/Augusta University, Augusta, Georgia, USA
| | - Claudio Viscoli
- Division of Infectious Disease, University of Genova and San Martino University Hospital, Genova, Italy
| | - Thomas J Walsh
- Weill Cornell Medicine of Cornell University, Departments of Medicine, Pediatrics, Microbiology & Immunology, New York, New York, USA
| | - Adilia Warris
- MRC Centre for Medical Mycology at the University of Aberdeen, Aberdeen, UK
| | | | - P Lewis White
- Public Health Wales Mycology Reference Laboratory, University Hospital of Wales, Heath Park, Cardiff, UK
| | - Theoklis E Zaoutis
- Perelman School of Medicine at the University of Pennsylvania, Children’s Hospital of Philadelphia and Roberts Center for Pediatric Research, Philadelphia, Pennsylvania, USA
| | - Peter G Pappas
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Digestive enzymes of fungal origin as a relevant cause of false positive Aspergillus antigen testing in intensive care unit patients. Infection 2020; 49:241-248. [PMID: 32880845 PMCID: PMC7990814 DOI: 10.1007/s15010-020-01506-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 08/12/2020] [Indexed: 12/28/2022]
Abstract
Background Galactomannan antigen (GM) testing is widely used in the diagnosis of invasive aspergillosis (IA). Digestive enzymes play an important role in enzyme substitution therapy in exocrine pancreatic insufficiency. As digestive enzymes of fungal origin like Nortase contain enzymes from Aspergillus, a false-positive result of the test might be possible because of cross-reacting antigens of the cell wall of the producing fungi. We, therefore, asked whether the administration of fungal enzymes is a relevant cause of false-positive GM antigen test results. Methods Patients with a positive GM antigen test between January 2016 and April 2020 were included in the evaluation and divided into two groups: group 1—Nortase-therapy, group 2—no Nortase-therapy. In addition, dissolved Nortase samples were analyzed in vitro for GM and β-1,3-D-glucan. For statistical analysis, the chi-squared and Mann‒Whitney U tests were used. Results Sixty-five patients were included in this evaluation (30 patients receiving Nortase and 35 patients not receiving Nortase). The overall false positivity rate of GM testing was 43.1%. Notably, false-positive results were detected significantly more often in the Nortase group (73.3%) than in the control group (17.1%, p < 0.001). While the positive predictive value of GM testing was 0.83 in the control group, there was a dramatic decline to 0.27 in the Nortase group. In vitro analysis proved that the Nortase enzyme preparation was highly positive for the fungal antigens GM and β-1,3-D-glucan. Conclusions Our data demonstrate that the administration of digestive enzymes of fungal origin like Nortase leads to a significantly higher rate of false-positive GM test results compared to that in patients without digestive enzyme treatment.
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Kang N, Park J, Jhun BW. Clinical Characteristics and Treatment Outcomes of Pathologically Confirmed Aspergillus Nodules. J Clin Med 2020; 9:jcm9072185. [PMID: 32664449 PMCID: PMC7408717 DOI: 10.3390/jcm9072185] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 07/03/2020] [Accepted: 07/08/2020] [Indexed: 01/06/2023] Open
Abstract
Aspergillus nodules represent a subtype of chronic pulmonary aspergillosis, but details on their characteristics and outcomes are limited. We evaluated 80 patients with pathologically confirmed Aspergillus nodules between January 2009 and December 2016. The median age of the patients was 59 years, and 46 (58%) were women. Seventy-three (91%) patients were surgically diagnosed with Aspergillus nodules and the remaining seven (9%) patients were diagnosed by percutaneous transthoracic needle biopsy. The median long-axis diameter of nodules was 22 mm, and nodules had an internal cavity in 49 (61%) patients. Spiculation and calcification were observed in 20% and 39% of patients, respectively. Ninety percent (18/20) of nodules showed uptake on positron emission tomography. Serum Aspergillus precipitin IgG antibody was positive in 42% (10/24) of tested patients. Seventy-three (91%) patients underwent surgery without (n = 58) or with (n = 15) adjuvant antifungal therapy, and the remaining seven (9%) patients received antifungal therapy alone (n = 5) or no treatment (n = 2). Three patients experienced postoperative pulmonary complications: pneumothorax, hemoptysis, and acute lung injury (n = 1 each). There was no recurrence during the median follow-up period of 36.8 months. In conclusion, surgery could be a treatment strategy worth considering for most Aspergillus nodules. However, given that our study population was heterogeneous, further well-designed studies are need.
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Affiliation(s)
- Noeul Kang
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea;
| | - Jiyeon Park
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea;
| | - Byung Woo Jhun
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea;
- Correspondence: ; Tel.: +82-2-3410-3429; Fax: +82-2-3410-3849
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Barrs VR, Talbot JJ. Fungal Rhinosinusitis and Disseminated Invasive Aspergillosis in Cats. Vet Clin North Am Small Anim Pract 2019; 50:331-357. [PMID: 31866094 DOI: 10.1016/j.cvsm.2019.10.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Fungal rhinosinusitis, including sinonasal aspergillosis (SNA) and sino-orbital aspergillosis (SOA), is the most common type of aspergillosis encountered in cats. Other focal forms of aspergillosis including disseminated invasive aspergillosis occur less frequently. SOA is an invasive mycosis that is increasingly recognized and is most commonly caused by Aspergillus felis, a close relative of Aspergillus fumigatus. SNA can be invasive or noninvasive and is most commonly caused by A fumigatus and Aspergillus niger. Molecular methods are required to correctly identify the fungi that cause SNA and SOA. SNA has a favorable prognosis with treatment, whereas the prognosis for SOA remains poor.
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Affiliation(s)
- Vanessa R Barrs
- City University of Hong Kong, Department of Infectious Diseases & Public Health, Jockey Club College of Veterinary Medicine, Kowloon, Hong Kong SAR, China.
| | - Jessica J Talbot
- Faculty of Veterinary Science, University Veterinary Teaching Hospital, Sydney, University of Sydney, Faculty of Science, Sydney School of Veterinary Science, Camperdown, New South Wales 2006, Australia
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Carlesse F, Daudt LE, Seber A, Dutra ÁP, Melo ASDA, Simões B, Macedo CRD, Bonfim C, Benites E, Gregianin L, Batista MV, Abramczyk M, Tostes V, Lederman HM, Lee MLDM, Loggetto S, Galvão de Castro Junior C, Colombo AL. A consensus document for the clinical management of invasive fungal diseases in pediatric patients with hematologic cancer and/or undergoing hematopoietic stem cell transplantation in Brazilian medical centers. Braz J Infect Dis 2019; 23:395-409. [PMID: 31738887 PMCID: PMC9428207 DOI: 10.1016/j.bjid.2019.09.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 09/10/2019] [Accepted: 09/28/2019] [Indexed: 01/05/2023] Open
Abstract
In the present paper we summarize the suggestions of a multidisciplinary group including experts in pediatric oncology and infectious diseases who reviewed the medical literature to elaborate a consensus document (CD) for the diagnosis and clinical management of invasive fungal diseases (IFDs) in children with hematologic cancer and those who underwent hematopoietic stem-cell transplantation. All major multicenter studies designed to characterize the epidemiology of IFDs in children with cancer, as well as all randomized clinical trials addressing empirical and targeted antifungal therapy were reviewed. In the absence of randomized clinical trials, the best evidence available to support the recommendations were selected. Algorithms for early diagnosis and best clinical management of IFDs are also presented. This document summarizes practical recommendations that will certainly help pediatricians to best treat their patients suffering of invasive fungal diseases.
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Affiliation(s)
- Fabianne Carlesse
- Instituto de Oncologia Pediátrica, UNIFESP, São Paulo, SP, Brazil; Universidade Federal de São Paulo, Escola Paulista de Medicina (EPM), UNIFESP, São Paulo, SP, Brazil.
| | - Liane Esteves Daudt
- Universidade do Rio Grande do Sul, Hospital das Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.
| | - Adriana Seber
- Hospital Samaritano de São Paulo, São Paulo, SP, Brazil; ABHH, Brazil.
| | | | | | - Belinda Simões
- Hospital das Clínicas de Ribeirão Preto-USP, São Paulo, SP, Brazil.
| | | | - Carmem Bonfim
- Hospital das Clínicas de Curitiba, Paraná, PR, Brazil.
| | | | - Lauro Gregianin
- Hospital das Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.
| | - Marjorie Vieira Batista
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo, SP, Brazil.
| | - Marcelo Abramczyk
- Hospital Infantil Darcy Vargas, Morumbi, SP, Brazil; Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Pediatria, São Paulo, SP, Brazil.
| | - Vivian Tostes
- Pro-Imagem medicina diagnóstica Ribeirão Preto, SP, Brazil.
| | | | - Maria Lúcia de Martino Lee
- Hospital Santa Marcelina TUCA, São Paulo, SP, Brazil; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | | | | | - Arnaldo Lopes Colombo
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Disciplina de Infectologia, Brazil.
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del Rocío Reyes-Montes M, Duarte-Escalante E, Guadalupe Frías-De-León M, Obed Martínez-Herrera E, Acosta-Altamirano G. Molecular Diagnosis of Invasive Aspergillosis. Mol Med 2019. [DOI: 10.5772/intechopen.78694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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38
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Raval KM, Ghormade V, Rajamohanan PR, Choudhary H, Rudramurthy SM, Chakrabarti A, Paknikar K. Development of a nano-gold immunodiagnostic assay for rapid on-site detection of invasive aspergillosis. J Med Microbiol 2019; 68:1341-1352. [PMID: 31355743 DOI: 10.1099/jmm.0.001040] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Introduction. Timely detection of invasive aspergillosis (IA) caused by fungal pathogens, i.e. Aspergillus fumigatus and Aspergillus flavus, in immunocompromised patients is crucial in preventing high mortality.Aim. To develop a simple immunoassay for the detection of galactomannan (GM), an IA biomarker.Methodology. GM from A. fumigatus and A. flavus clinical strains was purified and characterized by X-ray diffraction, IR spectroscopy and 13C/1H nuclear magnetic resonance (NMR) for polyclonal antibody (pAb) production in rabbits. An enzyme-linked immunosorbent assay (ELISA) was standardized using concanavalin A to capture Aspergillus GM and pAbs to detect it. Gold nanoparticles (AuNPs) were synthesized and conjugated to pAbs for the development of a dot-blot immunoassay. The developed dot-blot was evaluated with 109 clinical serum and bronchoalveolar lavage samples.Results. Spectroscopy studies characterized the d-galactofuranosyl groups of GM responsible for the immune response and generation of pAbs. The ELISA employing pAbs showed a sensitivity of 1 ng ml-1 for Aspergillus GM. Furthermore, a sensitive, visual, rapid dot-blot assay developed by the conjugation of pAbs to AuNPs (~24±5 nm size, -36±2 mV zeta potential) had a detection limit of 1 pg ml-1 in serum. The pAbs interacted with Aspergillus spp. but did not cross-react with other fungal pathogen genera such as Penicillium and Candida. Evaluation of the dot-blot with 109 clinical samples showed high sensitivity (80 %) and specificity (93.2 %), with an overall assay accuracy of 89%.Conclusion. The developed nano-gold immunodiagnostic assay has immense potential for practical use in rapid, specific and sensitive on-site diagnosis of IA, even under resource-limited settings.
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Affiliation(s)
- Komal M Raval
- Savitribai Phule Pune University, Ganeshkhind, Pune 411007, India.,Nanobioscience Group, Agharkar Research Institute, Pune 411004, India
| | - Vandana Ghormade
- Nanobioscience Group, Agharkar Research Institute, Pune 411004, India.,Savitribai Phule Pune University, Ganeshkhind, Pune 411007, India
| | - P R Rajamohanan
- Central NMR Facility, National Chemical Laboratory, Pune 411008, India
| | - Hansraj Choudhary
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Shivaprakash M Rudramurthy
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Arunaloke Chakrabarti
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Kishore Paknikar
- Nanobioscience Group, Agharkar Research Institute, Pune 411004, India.,Savitribai Phule Pune University, Ganeshkhind, Pune 411007, India
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Lester R, Church D, Ambasta A. Disseminated cerebral aspergillosis complicated by thrombotic microangiopathy. Med Mycol Case Rep 2019; 25:25-28. [PMID: 31334000 PMCID: PMC6620712 DOI: 10.1016/j.mmcr.2019.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 06/26/2019] [Accepted: 07/04/2019] [Indexed: 11/20/2022] Open
Abstract
Invasive aspergillosis (IA) is a serious condition that can affect almost any organ. Cerebral aspergillosis itself is rapidly fatal without treatment. We report a case of disseminated cerebral IA in a patient exposed to cyclophosphamide, rituximab and prednisone. This case is unique because: 1) disseminated IA has not been described in anti-glomerular basement membrane glomerulonephritis; 2) IA led to thrombotic microangiopathy with normal ADAMTS13 and 3) voriconazole toxicity necessitated use of isavuconazole for IA treatment.
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Affiliation(s)
- Robynn Lester
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Deirdre Church
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Pathology & Laboratory Medicine and Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Anshula Ambasta
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Medicine, University of Calgary, Calgary, Alberta, Canada.,Ward of the 21 Century, University of Calgary, Calgary, Alberta, Canada
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Maurer E, Aigner M, Lass-Flörl C, Binder U. Hypoxia Decreases Diagnostic Biomarkers for Aspergillosis In Vitro. J Fungi (Basel) 2019; 5:jof5030061. [PMID: 31336719 PMCID: PMC6787614 DOI: 10.3390/jof5030061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 07/04/2019] [Accepted: 07/09/2019] [Indexed: 11/17/2022] Open
Abstract
The aim of the study was to evaluate the influence of hypoxia on galactomannan and (1,3)-β-d-glucan release of clinically relevant Aspergilli in vitro. Hypoxia decreased biomass and consequently led to lower biomarker release. However, when normalized to biomass, hypoxia led to increased levels of biomarkers at early growth stages (24 h). Antifungals (amphotericin B and voriconazole) decreased the galactomannan amount of A. fumigatus, even more prominently in hypoxia.
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Affiliation(s)
- Elisabeth Maurer
- Department of Hygiene, Medical Microbiology and Public Health, Institute of Hygiene and Medical Microbiology, Medical University of Innsbruck, Schöpfstrasse 41, 6020 Innsbruck, Austria
| | - Maria Aigner
- Department of Hygiene, Medical Microbiology and Public Health, Institute of Hygiene and Medical Microbiology, Medical University of Innsbruck, Schöpfstrasse 41, 6020 Innsbruck, Austria
| | - Cornelia Lass-Flörl
- Department of Hygiene, Medical Microbiology and Public Health, Institute of Hygiene and Medical Microbiology, Medical University of Innsbruck, Schöpfstrasse 41, 6020 Innsbruck, Austria
| | - Ulrike Binder
- Department of Hygiene, Medical Microbiology and Public Health, Institute of Hygiene and Medical Microbiology, Medical University of Innsbruck, Schöpfstrasse 41, 6020 Innsbruck, Austria.
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Pongpech N, Rotjanapan P. Absence of cutaneous involvement in disseminated Talaromyces marneffei infection in an AIDS patient: a case report and literature review. Infect Drug Resist 2019; 12:1493-1499. [PMID: 31239726 PMCID: PMC6556212 DOI: 10.2147/idr.s207819] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 05/17/2019] [Indexed: 12/24/2022] Open
Abstract
Background Talaromyces marneffei (T. marneffei) is an important opportunistic pathogen found in human immunodeficiency virus-positive individuals in Southeast Asia, Southern China, and Northeastern India. Patients with disseminated talaromycosis commonly develop multi-organ involvement including the skin. In this report, we describe the clinical presentation, investigation, management, and clinical outcome of an acquired immune deficiency syndrome (AIDS) patient with newly diagnosed disseminated talaromycosis without skin involvement. Case presentation A 27-year-old male with AIDS presented with acute onset of abdominal pain for 4 days and fever for 2 days. He had been diagnosed with AIDS, pneumocystis pneumonia, and presumptive smear-negative pulmonary tuberculosis 2 months previously. His initial CD4 count was 91 cells/mm3. After a 3-week course of trimethoprim/sulfamethoxazole and anti-tuberculosis treatment, anti-retroviral therapy was initiated. Physical examination revealed left upper quadrant tenderness but no abnormal skin lesions. On this visit, his CD4 count rose to 272 cells/mm3 (19%). Computed tomography of the abdomen showed evidence of a small hypodense lesion with a thin enhancing rim at the spleen and extensive intra-abdominal lymphadenopathy. Empirical amphotericin B deoxycholate was administered in response to positive serum galactomannan, although this was switched to intravenous liposomal amphotericin B 1 week later because of acute kidney injury. Blood and bone marrow cultures for fungus grew T. marneffei on days 9 and 12, respectively. After 21 days of treatment, oral itraconazole replaced intravenous therapy. The patient was discharged home after 29 days in the hospital and continued to improve clinically at a follow-up visit as an outpatient. Conclusion Talaromycosis is a fairly common opportunistic infection among AIDS patients in Thailand, despite a rise in CD4 count which may reflect a change in immune status. To a lesser extent, a systemic disease without skin involvement can be expected in real clinical practice.
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Affiliation(s)
- Nisha Pongpech
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Porpon Rotjanapan
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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de Heer K, Gerritsen MG, Visser CE, Leeflang MMG. Galactomannan detection in broncho-alveolar lavage fluid for invasive aspergillosis in immunocompromised patients. Cochrane Database Syst Rev 2019; 5:CD012399. [PMID: 31107543 PMCID: PMC6526785 DOI: 10.1002/14651858.cd012399.pub2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Invasive aspergillosis (IA) is a life-threatening opportunistic mycosis that occurs in some people with a compromised immune system. The serum galactomannan enzyme-linked immunosorbent assay (ELISA) rapidly gained widespread acceptance as part of the diagnostic work-up of a patient suspected of IA. Due to its non-invasive nature, it can be used as a routine screening test. The ELISA can also be performed on bronchoalveolar lavage (BAL), allowing sampling of the immediate vicinity of the infection. The invasive nature of acquiring BAL, however, changes the role of the galactomannan test significantly, for example by precluding its use as a routine screening test. OBJECTIVES To assess the diagnostic accuracy of galactomannan detection in BAL for the diagnosis of IA in people who are immunocompromised, at different cut-off values for test positivity, in accordance with the Cochrane Diagnostic Test Accuracy Handbook. SEARCH METHODS We searched three bibliographic databases including MEDLINE on 9 September 2016 for aspergillosis and galactomannan as text words and subject headings where appropriate. We checked reference lists of included studies for additional studies. SELECTION CRITERIA We included cohort studies that examined the accuracy of BAL galactomannan for the diagnosis of IA in immunocompromised patients if they used the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) classification as reference standard. DATA COLLECTION AND ANALYSIS Two review authors assessed study quality and extracted data. Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) was used for quality assessment. MAIN RESULTS We included 17 studies in our review. All studies except one had a high risk of bias in two or more domains. The diagnostic performance of an optical density index (ODI) of 0.5 as cut-off value was reported in 12 studies (with 1123 patients). The estimated sensitivity was 0.88 (95% confidence interval (CI) 0.75 to 1.00) and specificity 0.81 (95% CI 0.71 to 0.91). The performance of an ODI of 1.0 as cut-off value could be determined in 11 studies (with 648 patients). The sensitivity was 0.78 (95% CI 0.61 to 0.95) and specificity 0.93 (95% CI 0.87 to 0.98). At a cut-off ODI of 1.5 or higher, the heterogeneity in specificity decreased significantly and was invariably >90%. AUTHORS' CONCLUSIONS The optimal cut-off value depends on the local incidence and clinical pathway. At a prevalence of 12% a hypothetical population of 1000 patients will consist of 120 patients with IA. At a cut-off value of 0.5 14 patients with IA will be missed and there will be 167 patients incorrectly diagnosed with IA. If we use the test at a cut-off value of 1.0, we will miss 26 patients with IA. And there will be 62 patients incorrectly diagnosed with invasive aspergillosis. The populations and results were very heterogeneous. Therefore, interpretation and extrapolation of these results has to be performed with caution. A test result of 1.5 ODI or higher appears a strong indicator of IA.
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Affiliation(s)
- Koen de Heer
- FlevoziekenhuisDepartment of Internal MedicineAlmereNetherlands
- Academic Medical CenterDepartment of HematologyAmsterdamNetherlands
| | | | - Caroline E Visser
- Academic Medical CentreDepartment of Medical MicrobiologyAmsterdamNetherlands
| | - Mariska MG Leeflang
- Amsterdam University Medical Centers, University of AmsterdamDepartment of Clinical Epidemiology, Biostatistics and BioinformaticsP.O. Box 22700AmsterdamNetherlands1100 DE
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Ueno M, Nakano K, Yoshinari H, Nakayamada S, Iwata S, Kubo S, Miyagawa I, Tanaka Y. An Autopsy Case with Cerebral Hemorrhaging due to disseminated Aspergillosis During Glucocorticoid Therapy for Overlap Syndrome of Systemic Lupus Erythematosus and Systemic Sclerosis. Intern Med 2019; 58:1023-1027. [PMID: 30568120 PMCID: PMC6478969 DOI: 10.2169/internalmedicine.1226-18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We encountered a 60-year-old female patient who died of cerebral hemorrhage caused by disseminated aspergillosis during massive steroid therapy for overlap syndrome of systemic lupus erythematosus (SLE) and systemic sclerosis (SSc) and performed autopsy. Histologically, necrotizing vasculitis accompanied by Aspergillus hyphae was noted in the arterial wall of the region with cerebral hemorrhage and an abscess containing Aspergillus clumps was present in the lung, therefor we considered the cerebral hemorrhage caused by disseminated aspergillosis. For immunocompromised patients, it is desirable to perform treatment taking the possibility of deep mycosis into consideration, and when it is suspected, early therapeutic intervention may be useful.
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Affiliation(s)
- Masanobu Ueno
- The First Department of Internal Medicine, University of Occupational and Environmental Health, Japan
| | - Kazuhisa Nakano
- The First Department of Internal Medicine, University of Occupational and Environmental Health, Japan
| | - Hiroko Yoshinari
- The First Department of Internal Medicine, University of Occupational and Environmental Health, Japan
| | - Shingo Nakayamada
- The First Department of Internal Medicine, University of Occupational and Environmental Health, Japan
| | - Shigeru Iwata
- The First Department of Internal Medicine, University of Occupational and Environmental Health, Japan
| | - Satoshi Kubo
- The First Department of Internal Medicine, University of Occupational and Environmental Health, Japan
| | - Ippei Miyagawa
- The First Department of Internal Medicine, University of Occupational and Environmental Health, Japan
| | - Yoshiya Tanaka
- The First Department of Internal Medicine, University of Occupational and Environmental Health, Japan
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Verma N, Singh S, Taneja S, Duseja A, Singh V, Dhiman RK, Chakrabarti A, Chawla YK. Invasive fungal infections amongst patients with acute-on-chronic liver failure at high risk for fungal infections. Liver Int 2019; 39:503-513. [PMID: 30276951 DOI: 10.1111/liv.13981] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 09/12/2018] [Accepted: 09/25/2018] [Indexed: 12/14/2022]
Abstract
AIMS To study the prevalence, risk factors, role of serum biomarkers for diagnosis and impact of invasive fungal infections (IFIs) in patients with acute-on-chronic liver failure (ACLF). METHODS An analysis of IFI in patients with ACLF (EASL criteria) was conducted retrospectively. The diagnosis of IFI in clinically suspected patients was based on EORTC/MSG criteria. The demographical, clinical, laboratory details and outcomes were analysed. RESULTS Out of 264 patients with ACLF, 54 (20.4%) patients with suspicion of IFI were evaluated and IFI was diagnosed in 39 (14.7%). Invasive candidiasis was documented in 25 (64.1%) and invasive aspergillosis in 14 (35.8%). The most common source of infection was respiratory (n = 13) followed by renal (n = 7) and spontaneous fungal peritonitis (n = 6). On univariate analysis, diabetes mellitus, hemodialysis, prior antibiotic use, cerebral and respiratory organ failures, Chronic Liver Failure Consortium (CLIF-OF and CLIF-C ACLF) scores were predictors for development of IFI (P < 0.05). On multivariate analysis, hemodialysis and prior antibiotics use predicted the development of IFI (P < 0.05). Non-survivors were more likely to have IFI (P = 0.029), high CLIF-OF and CLIF-C ACLF scores (P < 0.001; for both) and higher 1,3-β D Glucan (BDG) levels (P = 0.009). The sensitivity, specificity, and AUROC of BDG (80 pg/mL) and Galactomannan index (GMI [0.5]) for diagnosing IFI were 97.4%, 60%, 0.770% and 43.6%, 100%, 0.745 respectively. CONCLUSIONS Invasive fungal infections constitutes an important cause of mortality in ACLF patients. BDG and GMI can be useful markers to guide antifungal therapy in patients at high risk for IFI.
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Affiliation(s)
- Nipun Verma
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shreya Singh
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sunil Taneja
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajay Duseja
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Virendra Singh
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Radha K Dhiman
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arunaloke Chakrabarti
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Yogesh K Chawla
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Krylov VB, Solovev AS, Argunov DA, Latgé JP, Nifantiev NE. Reinvestigation of carbohydrate specificity of EB-A2 monoclonal antibody used in the immune detection of Aspergillus fumigatus galactomannan. Heliyon 2019; 5:e01173. [PMID: 30766929 PMCID: PMC6360342 DOI: 10.1016/j.heliyon.2019.e01173] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 12/20/2018] [Accepted: 01/23/2019] [Indexed: 02/07/2023] Open
Abstract
Great progresses have been made in the recent years in the detection of circulating galactofuranose-bearing molecules for the diagnosis of aspergillosis. However, the test used in the clinical practice is hampered by the occurrence of false positives. A glycoarray with dozens of oligosaccharides structurally related to the Aspergillus fumigatus galactomannan has allowed us to reinvestigate the carbohydrate specificity of the EB-A2 monoclonal antibody used in the PlateliaTM Aspergillus sandwich immune assay. We have now demonstrated that the mAb can recognize shorter oligosaccharides than the previously reported tetrasaccharide Galf-β-(1→5)-Galf-β-(1→5)-Galf-β-(1→5)-Galf-β and oligosaccharides which contains alternating β-(1→5)/β-(1→6)-linkages. This result could explain the occurrence of false-positive signals due to the presence of the abovementioned epitopes not only in A. fumigatus galactomannan but also in other bacteria and fungi.
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Affiliation(s)
- Vadim B. Krylov
- N.D. Zelinsky Institute of Organic Chemistry, Russian Academy of Sciences, Leninsky Prospect 47, 119991 Moscow, Russia
| | - Arsenii S. Solovev
- N.D. Zelinsky Institute of Organic Chemistry, Russian Academy of Sciences, Leninsky Prospect 47, 119991 Moscow, Russia
| | - Dmitry A. Argunov
- N.D. Zelinsky Institute of Organic Chemistry, Russian Academy of Sciences, Leninsky Prospect 47, 119991 Moscow, Russia
| | - Jean-Paul Latgé
- Unité des Aspergillus, Institut Pasteur, 25 Rue du Docteur Roux, 75724 Paris Cedex 15, France
- Corresponding author.
| | - Nikolay E. Nifantiev
- N.D. Zelinsky Institute of Organic Chemistry, Russian Academy of Sciences, Leninsky Prospect 47, 119991 Moscow, Russia
- Corresponding author.
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Patterson TF, Donnelly JP. New Concepts in Diagnostics for Invasive Mycoses: Non-Culture-Based Methodologies. J Fungi (Basel) 2019; 5:E9. [PMID: 30658509 PMCID: PMC6463019 DOI: 10.3390/jof5010009] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 01/14/2019] [Accepted: 01/15/2019] [Indexed: 12/22/2022] Open
Abstract
Non-culture-based diagnostics have been developed to help establish an early diagnosis of invasive fungal infection. Studies have shown that these tests can significantly impact the diagnosis of infection in high risk patients. Aspergillus galactomannan EIA testing is well-recognized as an important adjunct to the diagnosis of invasive aspergillosis and can be detected in serum, bronchoalveolar lavage and other fluids. Galactomannan testing used along with PCR testing has been shown to be effective when integrated into care paths for high risk patients for both diagnoses and as a surrogate marker for outcome when used in serial testing. Beta-d-glucan assays are non-specific for several fungal genera including Aspergillus and Candida and in high risk patients have been an important tool to augment the diagnosis. Lateral flow technology using monoclonal antibodies to Aspergillus are available that allow rapid testing of clinical samples. While standard PCR for Candida remains investigational, T2 magnetic resonance allows for the rapid diagnosis of Candida species from blood cultures. Aspergillus PCR has been extensively validated with standardized approaches established for these methods and will be included in the diagnostic criteria in the revised European Organization for Research and Treatment of Cancer/Mycoses Study Group (EORTC-MSG) definitions. Finally, these non-culture-based tests can be used in combination to significantly increase the detection of invasive mycoses with the ultimate aim of establishing an early diagnosis of infection.
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Affiliation(s)
- Thomas F Patterson
- Division of Infectious Diseases, San Antonio Center for Medical Mycology, The University of Texas Health Science Center at San Antonio and the South Texas Veterans Health Care System, 7703 Floyd Curl Drive-MSC 7881, San Antonio, TX 78229-3900, USA.
| | - J Peter Donnelly
- Division of Infectious Diseases, San Antonio Center for Medical Mycology, The University of Texas Health Science Center at San Antonio and the South Texas Veterans Health Care System, 7703 Floyd Curl Drive-MSC 7881, San Antonio, TX 78229-3900, USA.
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Herrera S, Husain S. Current State of the Diagnosis of Invasive Pulmonary Aspergillosis in Lung Transplantation. Front Microbiol 2019; 9:3273. [PMID: 30687264 PMCID: PMC6333628 DOI: 10.3389/fmicb.2018.03273] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 12/17/2018] [Indexed: 01/06/2023] Open
Abstract
As the number of lung transplants performed worldwide each year continues to grow, the success of this procedure is threatened by the incidence of non-CMV infections such as invasive aspergillosis. Despite tremendous efforts and the availability of numerous diagnostic tests (especially in hematological malignancies) the diagnosis of invasive aspergillosis continues to be a challenge. Lung transplantation remains a unique clinical scenario, where additional host defenses are immunocompromized, making many of the available tests unsuitable. In this review we will navigate through the myriad of diagnostic tests currently available and how they apply to this unique patient population, as well as have a look into what the future holds.
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Affiliation(s)
- Sabina Herrera
- Transplant Infectious Diseases, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Shahid Husain
- Transplant Infectious Diseases, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
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Gao S, Zheng X, Tang Y, Cheng Y, Hu X, Wu J. Development of a Fluorescently Labeled Aptamer Structure-Switching Assay for Sensitive and Rapid Detection of Gliotoxin. Anal Chem 2019; 91:1610-1618. [PMID: 30567425 DOI: 10.1021/acs.analchem.8b05094] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Gliotoxin, one of the most toxic metabolites produced during the growth of Aspergillus fumigatus, can cause direct damage to the immune system and results in infection and spread of Aspergillus, or even leads to invasive aspergillosis. Accurate, rapid, and sensitive detection of the disease-specific marker gliotoxin, particularly in serum, urine, or other body fluids, is therefore an important approach to achieving early and rapid diagnosis of Invasive Aspergillus Fumigatus Infection (IAFI). In this study, aptamers that specifically bind to gliotoxin were successfully obtained using immobilization-free GO-SELEX technology. Furthermore, the performance of the aptamer, including binding affinity, targeting specificity, and structural stability, was further improved by optimizing through truncation and mutation. Finally, the optimized aptamer APT8T1M was used to develop a novel fluorescently labeled aptamer structure-switching assay (FLASSA) for the detection of gliotoxin. The method exhibited a good linear range from 0.1 nM to 100 nM of gliotoxin, with a lower detection limit of 0.05 nM. Moreover, FLASSA was applied to the detection of gliotoxin in spiked serum and urine samples. A good mean recovery of 98.76-110.85% and a low coefficient of variation (5.45-14.59%) were obtained, indicating a high degree of selectivity for gliotoxin, good reproducibility, and stability. These results show that the developed FLASSA has significant potential and offers an alternative to the traditional analytical methods for the rapid, sensitive, and efficient detection of gliotoxin, thus, providing an effective tool for the early and rapid diagnosis of IAFI.
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Affiliation(s)
- Shunxiang Gao
- Eye Institute, Eye and ENT Hospital , College of Medicine, Fudan University , Shanghai , China.,Shanghai Key Laboratory of Visual Impairment and Restoration , Science and Technology Commission of Shanghai Municipality , Shanghai , China.,NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia , Chinese Academy of Medical Sciences , Shanghai , China
| | - Xin Zheng
- Department of Clinical Laboratory , Longhua Hospital, Shanghai University of Traditional Chinese Medicine , Shanghai , China
| | - Yuan Tang
- Department of Gastrointestinal Surgery , Changzheng Hospital, Second Military Medical University , Shanghai , China
| | - Yajun Cheng
- Department of Orthopedics , Changhai Hospital, Second Military Medical University , Shanghai , China
| | - Xiaobo Hu
- Department of Clinical Laboratory , Longhua Hospital, Shanghai University of Traditional Chinese Medicine , Shanghai , China
| | - Jihong Wu
- Eye Institute, Eye and ENT Hospital , College of Medicine, Fudan University , Shanghai , China.,Shanghai Key Laboratory of Visual Impairment and Restoration , Science and Technology Commission of Shanghai Municipality , Shanghai , China.,NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia , Chinese Academy of Medical Sciences , Shanghai , China
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Dib RW, Hachem RY, Chaftari AM, Ghaly F, Jiang Y, Raad I. Treating invasive aspergillosis in patients with hematologic malignancy: diagnostic-driven approach versus empiric therapies. BMC Infect Dis 2018; 18:656. [PMID: 30545320 PMCID: PMC6293532 DOI: 10.1186/s12879-018-3584-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 12/03/2018] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Early antifungal therapy for invasive aspergillosis (IA) has been associated with improved outcome. Traditionally, of empiric antifungal therapy has been used for clinically suspected IA. We compared outcomes of patients with hematologic malignancy and IA who were treated with voriconazole using the diagnostic driven DDA (DDA-Vori) that includes galactomannan testing vs. empiric therapy with a non-voriconazole-containing regimen (EMP-non-Vori) or empiric therapy with voriconazole (EMP-Vori). METHODS We retrospectively reviewed the medical records of 342 hematologic malignancy patients diagnosed with proven, or probable IA between July 1993 and February 2016 at our medical center who received at least 7 days of DDA-Vori, EMP-Vori, or EMP-non-Vori. Outcome assessment included response to therapy (clinical and radiographic), all-cause mortality, and IA-attributable mortality. RESULTS By multivariate analysis, factors predictive of a favorable response included localized/sinus IA vs. disseminated/pulmonary IA (p < 0.0001), not receiving white blood cell transfusion (p < 0.01), and DDA-Vori vs. EMP-non-Vori (p < 0.0001). In contrast, predictors of mortality within 6 weeks of initiating IA therapy included disseminated/pulmonary infection vs. localized/sinus IA (p < 0.01), not undergoing stem cell transplantation within 1 year before IA (p = 0.01), and EMP-non-Vori vs. DDA-Vori (p < 0.001). CONCLUSIONS DDA-Vori was associated with better outcome (response and survival) compared with EMP-non-Vori and with equivalent outcome to EMP-Vori in hematologic malignancy patients. These outcomes associated with the implementation of DDA could lead to a reduction in the unnecessary costs and adverse events associated with the widespread use of empiric therapy.
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Affiliation(s)
- Rita Wilson Dib
- Department of Infectious Diseases, Infection Control & Employee Health, Unit 1460, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, USA
| | - Ray Y Hachem
- Department of Infectious Diseases, Infection Control & Employee Health, Unit 1460, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, USA.
| | - Anne-Marie Chaftari
- Department of Infectious Diseases, Infection Control & Employee Health, Unit 1460, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, USA
| | - Fady Ghaly
- Department of Infectious Diseases, Infection Control & Employee Health, Unit 1460, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, USA
| | - Ying Jiang
- Department of Infectious Diseases, Infection Control & Employee Health, Unit 1460, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, USA
| | - Issam Raad
- Department of Infectious Diseases, Infection Control & Employee Health, Unit 1460, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, USA
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50
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Farmakiotis D, Le A, Weiss Z, Ismail N, Kubiak DW, Koo S. False positive bronchoalveolar lavage galactomannan: Effect of host and cut-off value. Mycoses 2018; 62:204-213. [PMID: 30387195 DOI: 10.1111/myc.12867] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 10/28/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Bronchoalveolar lavage galactomannan (BAL-GM) is a mycological criterion for diagnosis of probable invasive aspergillosis (IA) per European Organization for Research and Treatment of Cancer/Mycoses Study Group (EORT-MSG) consensus criteria, but its real-world positive predictive value (PPV) has not been well-studied. Our aim was to estimate the PPV of BAL-GM in a contemporary cohort of patients with positive BAL-GM. METHODS We identified consecutive patients with ≥1 positive BAL-GM value (index ≥ 0.5) at Brigham and Women's Hospital from 11/2009 to 3/2016. We classified patients as having no, possible, probable, or proven IA, excluding BAL-GM as mycological criterion. RESULTS We studied 134 patients: 54% had hematologic malignancy (HM), and 10% were solid organ transplant (SOT) recipients. A total of 42% of positive (≥0.5) BAL-GM results were falsely positive (PPV 58%). The number of probable IA cases was increased by 23% using positive BAL-GM as mycologic criterion alone. PPV was higher in patients with HM or SOT (P < 0.001) and with use of higher thresholds for positivity (BAL-GM ≥ 1 vs 1-0.8 vs 0.8-0.5: P = 0.002). CONCLUSIONS 42% of positive BAL-GM values were falsely positive. We propose a critical reassessment of BAL-GM cutoff values in different patient populations. Accurate noninvasive tests for diagnosis of IA are urgently needed.
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Affiliation(s)
- Dimitrios Farmakiotis
- Division of Infectious Diseases, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Audrey Le
- Department of Internal Medicine, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Zoe Weiss
- Department of Internal Medicine, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Nour Ismail
- Brigham and Women's Hospital, Rhode Island Hospital, Division of Infectious Diseases, Harvard Medical School, Boston, Massachusetts
| | - David W Kubiak
- Brigham and Women's Hospital, Rhode Island Hospital, Division of Infectious Diseases, Harvard Medical School, Boston, Massachusetts
| | - Sophia Koo
- Brigham and Women's Hospital, Rhode Island Hospital, Division of Infectious Diseases, Harvard Medical School, Boston, Massachusetts
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