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Chang E, Kang SW, Huh JW, Kim MN, Bae S, Jung J, Kim MJ, Kim SH, Choi SH, Lee SO, Kim YS, Sung H, Chong YP. False positive Aspergillus galactomannan assay results caused by specific parenteral nutrition. Med Mycol 2023; 61:myad094. [PMID: 37656877 DOI: 10.1093/mmy/myad094] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 08/04/2023] [Accepted: 08/29/2023] [Indexed: 09/03/2023] Open
Abstract
In September 2022, the proportion of clinically false positive results with high index values for the galactomannan (GM) assay increased dramatically in our hospital and remained high until November 2022. We aimed to identify the possible causative agent that led to the dramatic increase in false positivity in GM assay. A case-control-control study was conducted, and patients admitted to two intensive care units between September and November 2022 were included. We defined each time point at which the GM assay was conducted in a patient as an episode and classified episodes into strong-positive (≥10.0 index; case), positive (control), and negative (<0.5 index; control) groups. We compared the medications administered in three groups and measured GM levels in relevant medications, including parenteral nutrition (PN). In total, 118 episodes in 33 patients were classified into three groups. There were 46 negative, 23 positive, and 49 strong-positive episodes, and there was a significant difference in the use of Winuf® PNs (P < .001) between the three groups. Forty episodes (82%) in the strong-positive group received Winuf®, compared with three (6.5%) in the negative group and one (4.3%) in the positive group (P < .001). All samples of Winuf® PNs used in the five patients whose GM results were repeatedly strong-positive were strongly positive for GM. False positivity in GM assay can be caused by the administration of specific PNs. A thorough investigation of prescribed medications should be considered when there is an abrupt increase in the proportion of strong-positive or positive GM results.
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Affiliation(s)
- Euijin Chang
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
| | - Sung-Woon Kang
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
| | - Jin-Won Huh
- Department of Pulmonology and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Mi-Na Kim
- Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seongman Bae
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
| | - Jiwon Jung
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
| | - Min Jae Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
| | - Sung-Han Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
| | - Sang-Ho Choi
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
| | - Sang-Oh Lee
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
| | - Yang Soo Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
| | - Heungsup Sung
- Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yong Pil Chong
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
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Ao K, Li X, Zhang W, Chen Z, Liu Y, Shu L, Xiao Y, Wu S, Xie Y, Kang M. Evaluation of the Autof ms1000 mass spectrometry for rapid clinical identification of filamentous fungi. BMC Microbiol 2023; 23:228. [PMID: 37608359 PMCID: PMC10464221 DOI: 10.1186/s12866-023-02968-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 08/02/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) has revolutionized microbial identification. However, there is a lack of data on its performance in identifying filamentous fungi. The objective of our study was to evaluate the accuracy of the Autof ms1000 mass spectrometry for identifying filamentous fungi in the clinical microbiology laboratory. RESULTS Among 106 samples tested using the Autof ms1000 system, 101 (95.28%) were identified at the genus or species level, and 81 (76.41%) were accurately identified at the species level. Additionally, we developed a new rapid formic acid extraction method with simple pretreatment for filamentous fungi that saved time and provided accurate results. CONCLUSIONS The Autof ms1000 mass spectrometer proved to be a valuable tool for identifying filamentous fungi. However, upgrading the database is recommended for correctly identifying rare strains.
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Affiliation(s)
- Keping Ao
- Department of Laboratory Medicine, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Chengdu, 610041, China
| | - Xiaohan Li
- Department of Laboratory Medicine, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Chengdu, 610041, China
| | - Weili Zhang
- Department of Laboratory Medicine, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Chengdu, 610041, China
| | - Zhixing Chen
- Department of Laboratory Medicine, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Chengdu, 610041, China
| | - Ya Liu
- Department of Laboratory Medicine, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Chengdu, 610041, China
| | - Ling Shu
- Department of Laboratory Medicine, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Chengdu, 610041, China
| | - Yuling Xiao
- Department of Laboratory Medicine, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Chengdu, 610041, China
| | - Siying Wu
- Department of Laboratory Medicine, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Chengdu, 610041, China
| | - Yi Xie
- Department of Laboratory Medicine, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Chengdu, 610041, China
| | - Mei Kang
- Department of Laboratory Medicine, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Chengdu, 610041, China.
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Calero AL, Alonso R, Gadea I, Vega MDM, García MM, Muñoz P, Machado M, Bouza E, García-Rodríguez J. Comparison of the Performance of Two Galactomannan Detection Tests: Platelia Aspergillus Ag and Aspergillus Galactomannan Ag Virclia Monotest. Microbiol Spectr 2022; 10:e0262621. [PMID: 35262395 PMCID: PMC9045373 DOI: 10.1128/spectrum.02626-21] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 02/11/2022] [Indexed: 12/14/2022] Open
Abstract
The use of nonculture-based biomarkers such as the determination of galactomannan is sought for the diagnosis of invasive aspergillosis. To investigate the comparative yield of two tests for the detection of galactomannan in patients with or without proven or probable invasive aspergillosis. Overall, 327 samples (327 patients) were analyzed in a retrospective/prospective study performed in 3 hospitals in Madrid, comparing the determination results in serum or bronchoalveolar lavage of two techniques for galactomannan detection, namely, Platelia Aspergillus Ag (Bio-Rad) and Aspergillus galactomannan Ag Virclia Monotest (Vircell S.L.), following the manufacturer's instructions. Both techniques can automate the process, but the second technique has the advantage of individual processing and assembly of each sample without the need for the additional expense of single-dose strips in controls. In total, 288 of the 327 tests performed showed concordant results between both techniques. The agreement between both methods was к = 0.722, and the correlation between indices was ρ = 0.718. Only 39 samples showed discordant results. In those 39 cases, there were 15 patients with proven or probable invasive aspergillosis criteria. For the samples with clinical criteria as a reference, the areas under the curve of the receiver operating characteristic (ROC) curve were 0.962 for Platelia and 0.968 for VirClia. The VirClia test has been proven to be an alternative for diagnosis due to its friendlier automated format than that of the usual Platelia routine test. The VirClia test also allows individual action and, therefore, a more immediate clinical response. IMPORTANCE Invasive mycoses are increasingly present in immunosuppressed or hospitalized patients with serious illnesses, leading to high rates of morbidity and mortality. Invasive aspergillosis is an infection caused, in a percentage greater than 50%, by the genus Aspergillus. It is vitally important to make an early diagnosis that leads to the application of antifungals in the initial stage of the infection. Therefore, tools are required to help with the early diagnosis of the infection. This comparative study of two enzyme immunoassays is based on the detection of galactomannan antigen in serum and bronchoalveolar lavage samples. A new design based on chemiluminescence and presented in an automated single-dose format is compared to a conventional ELISA technique marketed for years. The results obtained from the prospective and retrospective study indicate a high correlation and degree of agreement between both techniques, as well as in their diagnostic performance.
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Affiliation(s)
- Alba Leyva Calero
- Department of Biochemistry, Immunology and Molecular Parasitology, Universidad de Granada, Granada, Spain
| | - Roberto Alonso
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Biosanitaria Gregorio Marañón, Madrid, Spain
- CIBER de Enfermedades Respiratorias CIBERES, Barcelona, Spain
- Department of Medicine, Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - Ignacio Gadea
- Department of Clinical Microbiology, Fundación Jimenez Díaz, Autonomous University, Madrid, Spain
| | | | - Marta Martín García
- Department of Clinical Microbiology, Fundación Jimenez Díaz, Autonomous University, Madrid, Spain
| | - Patricia Muñoz
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Biosanitaria Gregorio Marañón, Madrid, Spain
- CIBER de Enfermedades Respiratorias CIBERES, Barcelona, Spain
- Department of Medicine, Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - Marina Machado
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Biosanitaria Gregorio Marañón, Madrid, Spain
- CIBER de Enfermedades Respiratorias CIBERES, Barcelona, Spain
| | - Emilio Bouza
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Biosanitaria Gregorio Marañón, Madrid, Spain
- CIBER de Enfermedades Respiratorias CIBERES, Barcelona, Spain
- Department of Medicine, Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - Julio García-Rodríguez
- Department of Clinical Microbiology, Hospital La Paz, Autonomous University, Madrid, Spain
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Hashim Z, Neyaz Z, Marak RSK, Nath A, Nityanand S, Tripathy NK. Practice Guidelines for the Diagnosis of COVID-19-Associated Pulmonary Aspergillosis in an Intensive Care Setting. J Intensive Care Med 2021; 37:985-997. [PMID: 34678103 PMCID: PMC9353310 DOI: 10.1177/08850666211047166] [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] [Indexed: 12/24/2022]
Abstract
Coronavirus disease-2019 (COVID-19)-associated pulmonary aspergillosis (CAPA) is a new disease characterized by secondary Aspergillus mold infection in patients with COVID-19. It primarily affects patients with COVID-19 in critical state with acute respiratory distress syndrome, requiring intensive care and mechanical ventilation. CAPA has a higher mortality rate than COVID-19, posing a serious threat to affected individuals. COVID-19 is a potential risk factor for CAPA and has already claimed a massive death toll worldwide since its outbreak in December 2019. Its second wave is currently progressing towards a peak, while the third wave of this devastating pandemic is expected to follow. Therefore, an early and accurate diagnosis of CAPA is of utmost importance for effective clinical management of this highly fatal disease. However, there are no uniform criteria for diagnosing CAPA in an intensive care setting. Therefore, based on a review of existing information and our own experience, we have proposed new criteria in the form of practice guidelines for diagnosing CAPA, focusing on the points relevant for intensivists and pulmonary and critical care physicians. The main highlights of these guidelines include the role of CAPA-appropriate test specimens, clinical risk factors, computed tomography of the thorax, and non-culture-based indirect and direct mycological evidence for diagnosing CAPA in the intensive care unit. These guidelines classify the diagnosis of CAPA into suspected, possible, and probable categories to facilitate clinical decision-making. We hope that these practice guidelines will adequately address the diagnostic challenges of CAPA, providing an easy-to-use and practical algorithm to clinicians for rapid diagnosis and clinical management of the disease.
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Affiliation(s)
- Zia Hashim
- 30093Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, India
| | - Zafar Neyaz
- 30093Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, India
| | - Rungmei S K Marak
- 30093Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, India
| | - Alok Nath
- 30093Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, India
| | - Soniya Nityanand
- 30093Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, India
| | - Naresh K Tripathy
- 30093Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, India
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5
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Russo A, Tiseo G, Falcone M, Menichetti F. Pulmonary Aspergillosis: An Evolving Challenge for Diagnosis and Treatment. Infect Dis Ther 2020; 9:511-524. [PMID: 32638227 PMCID: PMC7339098 DOI: 10.1007/s40121-020-00315-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Indexed: 02/07/2023] Open
Abstract
Aspergillus is a mold that may lead to different clinical pictures, from allergic to invasive disease, depending on the patient’s immune status and structural lung diseases. Chronic pulmonary aspergillosis is an infection with a locally invasive presentation, reported especially in patients with chronic pulmonary disease, while aspergilloma is typically found in patients with previously formed cavities in the lungs. Allergic bronchopulmonary aspergillosis is due to a hypersensitivity reaction to Aspergillus antigens and is more frequently described in patients with moderate-severe asthma or cystic fibrosis. Invasive pulmonary aspergillosis mainly occurs in patients with neutropenia or immunodeficiency, but has increasingly been recognized as an emerging disease of non-neutropenic patients. The significance of this infection has dramatically increased in recent years, considering the high number of patients with an impaired immune state associated with the management and treatment of neoplasm, solid or hematological transplantation, autoimmune diseases, and inflammatory conditions. Moreover, prolonged steroid treatment is recognized as an important risk factor, especially for invasive disease. In this setting, critically ill patients admitted to intensive care units and/or with chronic obstructive pulmonary disease could be at higher risk for invasive infection. This review provides an update on the clinical features and risk factors of pulmonary aspergillosis. Current approaches for the diagnosis, management, and treatment of these different forms of pulmonary aspergillosis are discussed.
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Affiliation(s)
- Alessandro Russo
- Division of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
| | - Giusy Tiseo
- Division of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Marco Falcone
- Division of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Francesco Menichetti
- Division of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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6
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Welte T, Len O, Muñoz P, Romani L, Lewis R, Perrella A. Invasive mould infections in solid organ transplant patients: modifiers and indicators of disease and treatment response. Infection 2019; 47:919-927. [PMID: 31576498 DOI: 10.1007/s15010-019-01360-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 09/18/2019] [Indexed: 02/06/2023]
Abstract
PURPOSE Invasive mould infections, in particular invasive aspergillosis (IA), are comparatively frequent complications of immunosuppression in patients undergoing solid organ transplantation (SOT). Guidelines provide recommendations as to the procedures to be carried out to diagnose and treat IA, but only limited advice for SOT recipients. METHODS Literature review and expert consensus summarising the existing evidence related to prophylaxis, diagnosis, treatment and assessment of response to IA and infections by Mucorales in SOT patients RESULTS: Response to therapy should be assessed early and at regular intervals. No indications of improvement should lead to a prompt change of the antifungal treatment, to account for possible infections by Mucorales or other moulds such as Scedosporium. Imaging techniques, especially CT scan and possibly angiography carried out at regular intervals during early and long-term follow-up and coupled with a careful clinical diagnostic workout, should be evaluated as diagnostic tools and outcome predictors, and standardised to improve therapy monitoring. The role of biomarkers such as the galactomannan test and PCR, as well as selected inflammation parameters, has not yet been definitively assessed in the SOT population and needs to be studied further. The therapeutic workup should consider a reduction of immunosuppressive therapy. CONCLUSIONS The role of immunosuppression and immune tolerance mechanisms in the response to invasive fungal infection treatment is an important factor in the SOT population and should not be underestimated. The choice of the antifungal should consider not only their toxicity but also their effects on the immune system, two features that are intertwined.
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Affiliation(s)
- Tobias Welte
- Department of Respiratory Medicine, Hannover Medical School, Carl Neuberg Str 1, 30625, Hannover, Germany.
| | - Oscar Len
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Patricia Muñoz
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Medicine Department, Universidad Complutense de Madrid, CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain
| | - Luigina Romani
- Department of Experimental Medicine, School of Medicine, University of Perugia, 06132, Perugia, Italy
| | - Russell Lewis
- Infectious Diseases Hospital, S. Orsola-Malpighi, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Alessandro Perrella
- VII, Department of Infectious Disease and Immunology, Hospital D. Cotugno, Naples, Italy
- CLSE-Liver Transplant Unit, Hospital A. Cardarelli, Naples, Italy
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Vaezi A, Fakhim H, Javidnia J, Khodavaisy S, Abtahian Z, Vojoodi M, Nourbakhsh F, Badali H. Pesticide behavior in paddy fields and development of azole-resistant Aspergillus fumigatus : Should we be concerned? J Mycol Med 2018; 28:59-64. [DOI: 10.1016/j.mycmed.2017.12.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 12/04/2017] [Accepted: 12/15/2017] [Indexed: 10/17/2022]
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Challenges and Solution of Invasive Aspergillosis in Non-neutropenic Patients: A Review. Infect Dis Ther 2017; 7:17-27. [PMID: 29273978 PMCID: PMC5840102 DOI: 10.1007/s40121-017-0183-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Indexed: 12/31/2022] Open
Abstract
Invasive aspergillosis (IA) is a serious opportunistic infection, which has increasingly been recognized as an emerging disease of non-neutropenic patients. In this group of patients, the diagnosis of IA can be challenging owing to the lack of specificity of symptoms, the difficulty in discriminating colonization from infection, and the lower sensitivity of microbiological and radiological tests compared with immunocompromised patients. The aim of this article is to present to clinicians a critical review on the management of IA in non-neutropenic patients.
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9
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Shen Y, Zhang X, Lin W, Wan C, Li Q, Jiang Y. Liquid-based cytopathology test as a novel method to identify Aspergillus in patients with pulmonary aspergillosis. Sci Rep 2017; 7:7528. [PMID: 28790413 PMCID: PMC5548770 DOI: 10.1038/s41598-017-07564-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 06/27/2017] [Indexed: 02/05/2023] Open
Abstract
Conventional cytopathology examination of respiratory samples can aid in identifying Aspergillus but with poor sensitivity, so this study aimed to assess the potential of the liquid-based cytopathology test (LCT) for improving the identification of Aspergillus in respiratory samples following Papanicolaou's or Special staining with Grocott's methenamine silver or periodic acid-Schiff staining. Paired bronchial brushing samples (n = 54) and sputum samples (n = 117) from 171 patients with pulmonary aspergillosis were prepared as slides using either conventional cytopathology or SurePath LCT. LCT slides were generally superior to conventional slides, showing smaller cell monolayer surface area, clearer background and more distinct stereoscopic cytological features. For Papanicolaou's staining, LCT-prepared slides allowed a higher positive rate of Aspergillus identification than conventional slides for bronchial brushing samples (59.25% vs. 20.37%, P < 0.05) and sputum samples (29.05% vs. 8.55%, P < 0.05). Similarly, Special staining of LCT-prepared slides showed a higher positive rate of Aspergillus identification for bronchial brushing samples (83.33% vs. 57.41%, P < 0.05) and sputum samples (43.59% vs. 19.66%, P < 0.05). This preliminary study suggests that LCT may be better than conventional slide preparation for identifying Aspergillus in respiratory samples from patients with pulmonary aspergillosis.
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Affiliation(s)
- Yongchun Shen
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University and Division of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, Chengdu, 610041, China
| | - Xiaorong Zhang
- Department of Pathology, The First Affiliated Hospital of Jiujiang University, Jiujiang, 332005, China
| | - Wenyi Lin
- Department of Pathology, Chengdu Womens' and Children's Central Hospital, Chengdu, 610091, China
| | - Chun Wan
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University and Division of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, Chengdu, 610041, China
| | - Qiyuan Li
- Department of Pathology, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Yong Jiang
- Department of Pathology, West China Hospital of Sichuan University, Chengdu, 610041, China.
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Bassetti M, Bouza E. Invasive mould infections in the ICU setting: complexities and solutions. J Antimicrob Chemother 2017; 72:i39-i47. [PMID: 28355466 DOI: 10.1093/jac/dkx032] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Infections caused by filamentous fungi represent a major burden in the ICU. Invasive aspergillosis is emerging in non-neutropenic individuals with predisposing conditions, e.g. corticosteroid treatment, chronic obstructive pulmonary disease, liver cirrhosis, solid organ cancer, HIV infection and transplantation. Diagnosis is challenging because the signs and symptoms are non-specific, and initiation of additional diagnostic examinations is often delayed because clinical suspicion is low. Isolation of an Aspergillus species from the respiratory tract in critically ill patients, and tests such as serum galactomannan, bronchoalveolar lavage 1-3-β-d-glucan and specific PCR should be interpreted with caution. ICU patients should start adequate antifungal therapy upon suspicion of invasive aspergillosis, without awaiting definitive proof. Voriconazole, and now isavuconazole, are the drugs of choice. Mucormycosis is a rare, but increasingly prevalent disease that occurs mainly in patients with uncontrolled diabetes mellitus, immunocompromised individuals or previously healthy patients with open wounds contaminated with Mucorales. A high proportion of cases are diagnosed in the ICU. Rapidly progressing necrotizing lesions in the rhino-sinusal area, the lungs or skin and soft tissues are the characteristic presentation. Confirmation of diagnosis is based on demonstration of tissue invasion by non-septate hyphae, and by new promising molecular techniques. Control of underlying predisposing conditions, rapid surgical resection and administration of liposomal amphotericin B are the main therapeutic actions, but new agents such as isavuconazole are a promising alternative. Patients with mucormycosis receive a substantial part of their care in ICUs and, despite advances in diagnosis and treatment, mortality remains very high.
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Affiliation(s)
- Matteo Bassetti
- Infectious Diseases Division, Santa Maria Misericordia University Hospital, Udine, Italy
| | - Emilio Bouza
- Department of Infectious Diseases and Clinical Microbiology, Universidad Complutense of Madrid, and CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
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11
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Tao T, Zhang YH, Xue SL, Wu DP, Chen F. Fulminant Laryngeal-tracheobronchial-pulmonary Aspergillosis: A Rare and Fatal Complication in Allogeneic Hematopoietic Stem Cell Transplantation Recipients. Intern Med 2017; 56:347-351. [PMID: 28154281 PMCID: PMC5348461 DOI: 10.2169/internalmedicine.56.7201] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
A 23-year-old man who had previously undergone allogeneic hematopoietic stem cell transplantation (allo-HSCT) for severe aplastic anemia was diagnosed with invasive laryngeal-tracheobronchial-pulmonary aspergillosis after presenting with a persistent dry cough at six months post-transplantation based on the findings of laryngoscopy and fiberoptic bronchoscopy. A fiberoptic bronchoscope was used to remove the obstructive material from the patient's airway and posaconazole plus caspofungin were administered to successfully to treat the patient. Our report suggests that laryngoscopy and fiberoptic bronchoscopy should be considered as alternative approaches to the diagnosis and treatment of allo-HSCT recipients with persistent respiratory symptoms when invasive laryngeal aspergillosis and invasive tracheobronchial aspergillosis are suspected.
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Affiliation(s)
- Tao Tao
- Department of Hematology, the Xinghai Hospital of Suzhou Industrial Park, China
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12
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Immunochemical analysis of fumigaclavine mycotoxins in respiratory tissues and in blood serum of birds with confirmed aspergillosis. Mycotoxin Res 2015; 31:177-83. [PMID: 26388046 DOI: 10.1007/s12550-015-0228-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 09/05/2015] [Accepted: 09/08/2015] [Indexed: 12/29/2022]
Abstract
The ergoline alkaloid fumigaclavine A (FuA) is one of the major mycotoxins produced by Aspergillus fumigatus, the main causative fungal agent of avian aspergillosis. To study in situ production of FuA, post-mortem respiratory tissues of various avian species, as well as blood samples of falcons (Falco sp.), were analysed by enzyme immunoassay (EIA). At a detection limit of 1.5 ng/ml, FuA EIA positive results were obtained for tissue samples from seven (64%) out of 11 birds with confirmed aspergillosis, with a maximum concentration of 38 ng/g, while all controls (n = 7) were negative. No FuA could be detected in blood serum (detection limit 0.7 ng/ml) of 15 falcons, experimentally inoculated with A. fumigatus conidia. Fungal mycelium material from tissue of clinical aspergillosis cases, cultured on malt extract agar, was highly positive in the FuA EIA in milligrams per gram range. Chromatographic analysis of mycelium extracts revealed the co-presence of FuA and the structurally related fumigaclavine C (FuC). Alkaline hydrolysis of FuA and FuC yielded the corresponding deacetylation products, FuB and FuE. This is the first report showing that fumigaclavine alkaloids are produced by A. fumigatus in situ during the course of clinical aspergillosis in birds; however, the role of these compounds in the pathogenesis of this disease is still unknown.
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Pan Z, Fu M, Zhang J, Zhou H, Fu Y, Zhou J. Diagnostic accuracy of a novel lateral-flow device in invasive aspergillosis: a meta-analysis. J Med Microbiol 2015; 64:702-707. [PMID: 26002943 DOI: 10.1099/jmm.0.000092] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Zhijie Pan
- Respiratory Department, The First Affiliated Hospital, College of Medicine, Zhejiang University, No. 79 Qingchun Road, Hangzhou, Zhejiang, PR China
| | - Mengjiao Fu
- Respiratory Department, The First Affiliated Hospital, College of Medicine, Zhejiang University, No. 79 Qingchun Road, Hangzhou, Zhejiang, PR China
| | - Jiaojiao Zhang
- Cancer Institute, The Second Affiliated Hospital, College of Medicine, Zhejiang University, No. 88 Jiefang Road, Hangzhou, Zhejiang, PR China
| | - Hua Zhou
- Respiratory Department, The First Affiliated Hospital, College of Medicine, Zhejiang University, No. 79 Qingchun Road, Hangzhou, Zhejiang, PR China
| | - Yiqi Fu
- Respiratory Department, The First Affiliated Hospital, College of Medicine, Zhejiang University, No. 79 Qingchun Road, Hangzhou, Zhejiang, PR China
| | - Jianying Zhou
- Respiratory Department, The First Affiliated Hospital, College of Medicine, Zhejiang University, No. 79 Qingchun Road, Hangzhou, Zhejiang, PR China
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Molecular Diagnosis in Fungal Infection Control. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2015. [DOI: 10.1007/s40506-015-0040-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Escribano P, Marcos-Zambrano LJ, Peláez T, Muñoz P, Padilla B, Bouza E, Guinea J. Sputum and bronchial secretion samples are equally useful as bronchoalveolar lavage samples for the diagnosis of invasive pulmonary aspergillosis in selected patients. Med Mycol 2015; 53:235-40. [PMID: 25631477 DOI: 10.1093/mmy/myu090] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
In the absence of histopathology studies of lung biopsies, the bronchoalveolar lavage (BAL) sample is preferred for the diagnosis of invasive pulmonary aspergillosis. Isolation of Aspergillus fumigatus from sputum and bronchial secretion samples are commonly interpreted as colonization or laboratory contamination, particularly in nonneutropenic patients. We studied if sputum/bronchial secretions and BAL samples are equally useful for the diagnosis of invasive pulmonary aspergillosis. We retrospectively selected 14 patients with proven (n = 1) or probable (n = 13) invasive pulmonary aspergillosis from whose samples A. fumigatus had been simultaneously isolated in BAL and sputum/bronchial secretions between 2006 and 2012. The isolates were identified by sequencing the β-tubulin gene and genotyped using the STRAf assay. Matches between BAL and sputum/bronchial secretions were observed in patients with identical genotypes in BAL and sputum/bronchial secretions. All patients had clinically suspected pneumonia, before the diagnosis of invasive pulmonary aspergillosis. The sample from which A. fumigatus was initially isolated was collected as a result of the presence of fever (50%), abnormal radiological findings (100%), and/or pneumonia that did not respond to antibiotics (36%). The underlying conditions varied, although the most common predisposing factors were hematological malignancies (21.5%) and COPD (43%). In 13 of the 14 patients (93%), we found matching genotypes in the BAL and the sputum/bronchial secretion samples. Genotyping showed that samples of sputum or bronchial secretions were equally useful as samples of BAL for the diagnosis of invasive pulmonary aspergillosis.
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Affiliation(s)
- Pilar Escribano
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain Instituto de Investigación Sanitaria del Hospital Gregorio Marañón CIBER de Enfermedades Respiratorias (CIBERES CB06/06/0058), Madrid, Spain
| | - Laura Judith Marcos-Zambrano
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain Instituto de Investigación Sanitaria del Hospital Gregorio Marañón
| | - Teresa Peláez
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain Instituto de Investigación Sanitaria del Hospital Gregorio Marañón CIBER de Enfermedades Respiratorias (CIBERES CB06/06/0058), Madrid, Spain Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Patricia Muñoz
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain Instituto de Investigación Sanitaria del Hospital Gregorio Marañón CIBER de Enfermedades Respiratorias (CIBERES CB06/06/0058), Madrid, Spain Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Belén Padilla
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain Instituto de Investigación Sanitaria del Hospital Gregorio Marañón CIBER de Enfermedades Respiratorias (CIBERES CB06/06/0058), Madrid, Spain
| | - Emilio Bouza
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain Instituto de Investigación Sanitaria del Hospital Gregorio Marañón CIBER de Enfermedades Respiratorias (CIBERES CB06/06/0058), Madrid, Spain Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Jesús Guinea
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain Instituto de Investigación Sanitaria del Hospital Gregorio Marañón CIBER de Enfermedades Respiratorias (CIBERES CB06/06/0058), Madrid, Spain Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
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