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Li Y, Qian Z, Chen H, Zhang S, Wang R, Yu S, Chen L, Wang L, Xu S, Tao Y. THE CLINICAL VALUE OF β-D-GLUCAN TESTING AND NEXT-GENERATION METAGENOMIC SEQUENCING FOR THE DIAGNOSIS OF FUNGAL ENDOPHTHALMITIS. Retina 2024; 44:1209-1216. [PMID: 38359396 DOI: 10.1097/iae.0000000000004073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
PURPOSE To explore the clinical value of β-D-glucan (BDG) testing and metagenomic next-generation sequencing (mNGS) for detecting the pathogens of fungal endophthalmitis (FE). METHODS This study included 32 cases (32 eyes) with FE and 20 cases (20 eyes) with intraocular inflammation caused by other etiologies. All patients underwent extraction of aqueous humor or vitreous fluid samples for BDG testing and mNGS. The diagnostic performance and total clinical concordance rate of BDG testing and mNGS for FE were evaluated and calculated based on the results of the clinical diagnosis. RESULTS Among the clinically diagnosed FE, the positivity rates of BDG testing and mNGS (90.63%) were both significantly higher ( P < 0.001) than that of microbial cultures (53.13%). There was 100% consistency in pathogen identification using mNGS and culture identification for culture-positive cases. The area under the curve was 0.927 for BDG testing and 0.853 for mNGS. When the two tests were combined, sensitivity (93.75%), specificity (100.00%), and total clinical concordance rate (96.15%) were all improved, compared with the single tests. CONCLUSION The positive rates of BDG test and mNGS were markedly higher than those of cultures in FE identification. The combination of these two tests showed improved performance when compared with individual tests.
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Affiliation(s)
- Yuxin Li
- Department of Ophthalmology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
- Joint Laboratory of Drug Delivery & Innovative Therapy Built By Beijing Chaoyang Hospital & State Key Laboratory of Biochemical Engineering, Institute of Process Engineering, Chinese Academy of Sciences, Beijing, China
| | - Zhuyun Qian
- Key Laboratory Jointly Built By the National Institute for Viral Disease Control and Prevention of China Centre for Disease Control and Prevention & Beijing GIANTMED Medical Diagnostics Lab, Beijing, China
- Beijing GIANTMED Medical Diagnostics Lab, Beijing, China
| | - Huagui Chen
- Medical College, Hunan Normal Universlty, Changsha, China
- Department of Clinical Laboratory, Aier Eye Hospital, Changsha, Hunan Province, China
| | - Shuguang Zhang
- Department of Ophthalmology, Zhengzhou Second People's Hospital, Zhengzhou, Henan, China; and
| | - Ruifeng Wang
- Department of Ophthalmology, Zhengzhou Second People's Hospital, Zhengzhou, Henan, China; and
| | - Shuhuan Yu
- Key Laboratory Jointly Built By the National Institute for Viral Disease Control and Prevention of China Centre for Disease Control and Prevention & Beijing GIANTMED Medical Diagnostics Lab, Beijing, China
- Beijing GIANTMED Medical Diagnostics Lab, Beijing, China
| | - Li Chen
- Department of Ophthalmology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
- Joint Laboratory of Drug Delivery & Innovative Therapy Built By Beijing Chaoyang Hospital & State Key Laboratory of Biochemical Engineering, Institute of Process Engineering, Chinese Academy of Sciences, Beijing, China
| | - Lu Wang
- Key Laboratory Jointly Built By the National Institute for Viral Disease Control and Prevention of China Centre for Disease Control and Prevention & Beijing GIANTMED Medical Diagnostics Lab, Beijing, China
- Beijing GIANTMED Medical Diagnostics Lab, Beijing, China
| | - Songtao Xu
- National Institute for Viral Disease Control and Prevention, China Centre for Disease Control and Prevention, Beijing, China
| | - Yong Tao
- Department of Ophthalmology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
- Joint Laboratory of Drug Delivery & Innovative Therapy Built By Beijing Chaoyang Hospital & State Key Laboratory of Biochemical Engineering, Institute of Process Engineering, Chinese Academy of Sciences, Beijing, China
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Watanabe S, Hoshina T, Miyamoto T, Suga S, Komatsu K, Tajiri R, Kusuhara K. A Preterm Infant of Congenital Cutaneous Candidiasis With Elevated Plasma (1, 3) β-D-glucan Level. Pediatr Infect Dis J 2024:00006454-990000000-00922. [PMID: 38916913 DOI: 10.1097/inf.0000000000004464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Affiliation(s)
- Shunsuke Watanabe
- Department of Pediatrics, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
- Department of Neonatology, General Perinatal Medical Center, Hospital of University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Takayuki Hoshina
- Department of Pediatrics, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Tomonari Miyamoto
- Department of Pediatrics, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Shutaro Suga
- Department of Pediatrics, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
- Department of Neonatology, General Perinatal Medical Center, Hospital of University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Kazuki Komatsu
- Department of Pathology and Oncology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Ryosuke Tajiri
- Department of Neonatology, General Perinatal Medical Center, Hospital of University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
- Department of Obstetrics and Gynecology, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Koichi Kusuhara
- Department of Pediatrics, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
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Guo XR, Zhang XG, Wang GS, Wang J, Liu XJ, Deng JH. Effect of Cinnamaldehyde on Systemic Candida albicans Infection in Mice. Chin J Integr Med 2024:10.1007/s11655-023-3754-5. [PMID: 38676827 DOI: 10.1007/s11655-023-3754-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2022] [Indexed: 04/29/2024]
Abstract
OBJECTIVE To investigate the therapeutic efficacy of cinnamaldehyde (CA) on systemic Candida albicans infection in mice and to provide supportive data for the development of novel antifungal drugs. METHODS Ninety BALB/c mice were randomly divided into 3 groups according to a random number table: CA treatment group, fluconazole (positive control) group, and Tween saline (negative control) group, with 30 mice in each group. Initially, all groups of mice received consecutive intraperitoneal injections of cyclophosphamide at 200 mg/kg for 2 days, followed by intraperitoneal injection of 0.25 mL C. albicans fungal suspension (concentration of 1.0 × 107 CFU/mL) on the 4th day, to establish an immunosuppressed systemic Candida albicans infection animal model. Subsequently, the mice were orally administered CA, fluconazole and Tween saline, at 240, 240 mg/kg and 0.25 mL/kg respectively for 14 days. After a 48-h discontinuation of treatment, the liver, small intestine, and kidney tissues of mice were collected for fungal direct microscopic examination, culture, and histopathological examination. Additionally, renal tissues from each group of mice were collected for (1,3)- β -D-glucan detection. The survival status of mice in all groups was monitored for 14 days of drug administration. RESULTS The CA group exhibited a fungal clearance rate of C. albicans above 86.7% (26/30), significantly higher than the fluconazole group (60.0%, 18/30, P<0.01) and the Tween saline group (30.0%, 9/30, P<0.01). Furthermore, histopathological examination in the CA group revealed the disappearance of inflammatory cells and near-normal restoration of tissue structure. The (1,3)-β-D-glucan detection value in the CA group (860.55 ± 126.73 pg/mL) was significantly lower than that in the fluconazole group (1985.13 ± 203.56 pg/mL, P<0.01) and the Tween saline group (5910.20 ± 320.56 pg/mL, P<0.01). The mouse survival rate reached 90.0% (27/30), higher than the fluconazole group (60.0%, 18/30) and the Tween saline group (30.0%, 9/30), with a significant difference between the two groups (both P<0.01). CONCLUSIONS CA treatment exhibited significant therapeutic efficacy in mice with systemic C. albicans infection. Therefore, CA holds potential as a novel antifungal agent for targeted treatment of C. albicans infection.
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Affiliation(s)
- Xiao-Ru Guo
- Department of Infectious Diseases, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, China
| | - Xiao-Guang Zhang
- Department of Dermatovenereology, Clinical Research Center for Dermatovenereology, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, China
| | - Gang-Sheng Wang
- The Second Hospital of Hebei Medical University, Quanbo Pharmaceuticals, Shijiazhuang, 050000, China
| | - Jia Wang
- Research Office, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, China
| | - Xiao-Jun Liu
- Department of Hematology, Second Hospital of Hebei Medical University, Shijiazhuang, 050000, China
| | - Jie-Hua Deng
- Department of Dermatovenereology, Clinical Research Center for Dermatovenereology, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, China.
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Bochennek K, Barnbrock A, Lehrnbecher T. Nonculture Diagnostics in Invasive Fungal Infections in Children. Pediatr Infect Dis J 2023; 42:e333-e335. [PMID: 37409829 DOI: 10.1097/inf.0000000000004043] [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: 07/07/2023]
Affiliation(s)
- Konrad Bochennek
- From the Department of Pediatrics, Division of Hematology, Oncology and Hemostaseology, Goethe University Frankfurt, Frankfurt, Germany
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Serum Beta-D-Glucan in the Diagnosis of Invasive Fungal Disease in Neonates, Children and Adolescents: A Critical Analysis of Current Data. J Fungi (Basel) 2022; 8:jof8121262. [PMID: 36547595 PMCID: PMC9783846 DOI: 10.3390/jof8121262] [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: 11/15/2022] [Revised: 11/27/2022] [Accepted: 11/29/2022] [Indexed: 12/02/2022] Open
Abstract
β-D-glucan (BDG) is a cell wall component of many pathogenic fungi. The detection of BDG as an assay is clinically broadly used as a diagnostic tool. However, the current data on BDG in paediatrics are limited, prompting specific considerations about when BDG can be used in neonates and children. We aimed to analyse the available data for the use of serum BDG in neonates and immunocompromised children and adolescents; as well as to understand the extent and characteristics of the use of BDG in children in Europe.
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VALUABLE APPLICATION OF THE β- d -GLUCAN TESTING OF INTRAOCULAR FLUID FOR THE DIAGNOSIS OF FUNGAL ENDOPHTHALMITIS. Retina 2022; 42:1560-1567. [PMID: 35877967 DOI: 10.1097/iae.0000000000003491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the value of the β- d -glucan (BDG) testing of intraocular fluid for the diagnosis of fungal endophthalmitis (FE). METHODS Twenty patients (22 eyes) with FE were diagnosed using both culture and nonculture methods. Intraocular fluid was collected for BDG testing, including 22 eyes of FE and 55 eyes of control group. Under different BDG cutoff points as the test-positives, the BDG sensitivity, specificity, positive predictive value, and negative predictive value for FE were analyzed. RESULTS The BDG testing value was 1,022.78 ± 1,362.40 pg/mL in the FE group, significantly higher than that of the control group (105.0 ± 180.80 pg/mL, P < 0.001). The area under the receiver operating characteristic (ROC) curve was 0.885 (95% confidence interval, 0.793-0.978; P < 0.001). With the prespecified BDG cutoff 107.83 pg/ml as the test-positive, sensitivity was 81.8%, specificity was 87.5%, and the Youden index was 0.693. When the BDG cutoff was depicted as 202.05 pg/mL, sensitivity reduced to 77.3%, specificity increased at 95.8%, and the Youden index reached the highest value of 0.731. CONCLUSIONS β- d -glucan testing of intraocular fluid demonstrated good sensitivity and specificity regarding the diagnosis of FE, which can provide earlier diagnosis to achieve better outcomes.
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Ferreras-Antolin L, Aziz N, Warris A. Serial (1-3)-beta-D-Glucan (BDG) monitoring shows high variability among premature neonates. Med Mycol 2022; 60:6585657. [PMID: 35561703 DOI: 10.1093/mmy/myac032] [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: 01/28/2022] [Revised: 04/05/2022] [Accepted: 05/09/2022] [Indexed: 11/13/2022] Open
Abstract
This study aimed to characterize the baseline values and dynamics of serum (1,3)-Beta-D-Glucan (BDG) in neonates at high risk of neonatal invasive candidiasis (NIC); as well as to determine the effect of various clinical variables on these levels. Single center prospective cohort study was performed including 20 high-risk neonates (gestational age < 29 weeks and/or birth weight ≤ 1000 gr). Samples for BDG (Fungitell® assay) were obtained twice weekly during 6 weeks. Nineteen neonates were enrolled with a median gestational age of 25 weeks (IQR 24-27), median birth weight of 730 gr (IQR 650-810). None of the neonates was diagnosed with NIC. 190 serum samples were included. The median BDG value was 59 pg/ml (IQR 30-148), mean was 119 pg/ml (SD ± 154). A total of 42.1% (80/190) samples showed values ≥80 pg/ml, with all the neonates presenting at least one test above this cut-off. Neonatal age did not show an association with BDG levels. Exposure to steroids and the use of a heel prick as sampling method were associated with statistically significant higher BDG levels. The BDG levels showed high variability and in a significant proportion of samples values were above the threshold for positivity (e.g., ≥80 pg/ml) in the absence of NIC. The exposure to postnatal steroids and the heel prick as the method of blood sampling were associated with higher BDG levels. LAY SUMMARY Neonatal invasive candidiasis (NIC) presents high morbi-mortality. The diagnosis of NIC is often challenging. Blood cultures have limitations and better diagnostic tools are needed. Beta-D-glucan is a diagnostic marker which could be potentially used, although still more clinical data are required.
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Affiliation(s)
- Laura Ferreras-Antolin
- St George's University Hospital NHS Foundation Trust, Paediatric Infectious Diseases Unit, London, United Kingdom.,MRC Centre for Medical Mycology, University of Exeter, United Kingdom
| | - Nasreen Aziz
- St. George's University Hospital NHS Foundation Trust, Neonatal Unit, London, United Kingdom
| | - Adilia Warris
- MRC Centre for Medical Mycology, University of Exeter, United Kingdom.,Great Ormond Street Hospital, Paediatric Infectious Diseases Unit, London, United Kingdom
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Keighley C, Cooley L, Morris AJ, Ritchie D, Clark JE, Boan P, Worth LJ. Consensus guidelines for the diagnosis and management of invasive candidiasis in haematology, oncology and intensive care settings, 2021. Intern Med J 2021; 51 Suppl 7:89-117. [DOI: 10.1111/imj.15589] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Caitlin Keighley
- Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney Camperdown New South Wales Australia
- Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR, New South Wales Health Pathology Westmead New South Wales Australia
- Southern IML Pathology, Sonic Healthcare Coniston New South Wales Australia
| | - Louise Cooley
- Department of Microbiology and Infectious Diseases Royal Hobart Hospital Hobart Tasmania Australia
- University of Tasmania Hobart Tasmania Australia
| | - Arthur J. Morris
- LabPLUS, Clinical Microbiology Laboratory Auckland City Hospital Auckland New Zealand
| | - David Ritchie
- Department of Clinical Haematology Peter MacCallum Cancer Centre and Royal Melbourne Hospital Melbourne Victoria Australia
| | - Julia E. Clark
- Department of Infection Management Queensland Children's Hospital, Children's Health Queensland Brisbane Queensland Australia
- Child Health Research Centre The University of Queensland Brisbane Queensland Australia
| | - Peter Boan
- PathWest Laboratory Medicine WA, Department of Microbiology Fiona Stanley Fremantle Hospitals Group Murdoch Western Australia Australia
- Department of Infectious Diseases Fiona Stanley Fremantle Hospitals Group Murdoch Western Australia Australia
| | - Leon J. Worth
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre Melbourne Victoria Australia
- Department of Infectious Diseases Peter MacCallum Cancer Centre Melbourne Victoria Australia
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Abdel-Haq N, Smith SM, Asmar BI. Micafungin injection for the treatment of invasive candidiasis in pediatric patients under 4 months of age. Expert Rev Anti Infect Ther 2021; 20:493-505. [PMID: 34882043 DOI: 10.1080/14787210.2022.2013807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Neonates and young infants with invasive candidiasis are particularly at increased risk of dissemination including hematogenous Candida meningoencephalitis. The echinocandins including micafungin have emerged as a preferred agent in most cases of candidemia and invasive candidiasis but data in pediatric patients under 4 months of age are limited. AREAS COVERED In this report, we review the micafungin use in infants younger than 4 months of age. Animal studies as well as clinical data that support its use in neonatal candidiasis are reviewed. In addition, the status of FDA approval and the rationale of micafungin dosing recommendations in infants <4 months are discussed. EXPERT OPINION A dose of 4 mg/kg was approved for treatment of candidemia, Candida peritonitis and abscesses excluding meningoencephalitis or ocular involvement in patients younger than 4 months of age. However, because of the risk of central nervous system dissemination as well as the difficulty in establishing this diagnosis, this dose is inadequate to treat ill infants with candidemia. More studies are needed to establish the safety and efficacy of micafungin daily dose of at least 10 mg/kg in infants younger than 4 months of age when hematogenous Candida meningoencephalitis or ocular involvement cannot be excluded.
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Affiliation(s)
- Nahed Abdel-Haq
- Division of Infection Diseases, Children's Hospital of Michigan, Detroit, MI, USA.,Children's Hospital of Michigan, Detroit, MI, USA.,Department of Pediatrics, Central Michigan University, Mount Pleasant, MI, USA.,Department of Pediatrics, Wayne State University, Detroit, MI, USA
| | | | - Basim I Asmar
- Division of Infection Diseases, Children's Hospital of Michigan, Detroit, MI, USA.,Children's Hospital of Michigan, Detroit, MI, USA.,Department of Pediatrics, Central Michigan University, Mount Pleasant, MI, USA.,Department of Pediatrics, Wayne State University, Detroit, MI, USA
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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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Cohen JF, Deeks JJ, Hooft L, Salameh JP, Korevaar DA, Gatsonis C, Hopewell S, Hunt HA, Hyde CJ, Leeflang MM, Macaskill P, McGrath TA, Moher D, Reitsma JB, Rutjes AWS, Takwoingi Y, Tonelli M, Whiting P, Willis BH, Thombs B, Bossuyt PM, McInnes MDF. Preferred reporting items for journal and conference abstracts of systematic reviews and meta-analyses of diagnostic test accuracy studies (PRISMA-DTA for Abstracts): checklist, explanation, and elaboration. BMJ 2021; 372:n265. [PMID: 33722791 PMCID: PMC7957862 DOI: 10.1136/bmj.n265] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
For many users of the biomedical literature, abstracts may be the only source of information about a study. Hence, abstracts should allow readers to evaluate the objectives, key design features, and main results of the study. Several evaluations have shown deficiencies in the reporting of journal and conference abstracts across study designs and research fields, including systematic reviews of diagnostic test accuracy studies. Incomplete reporting compromises the value of research to key stakeholders. The authors of this article have developed a 12 item checklist of preferred reporting items for journal and conference abstracts of systematic reviews and meta-analyses of diagnostic test accuracy studies (PRISMA-DTA for Abstracts). This article presents the checklist, examples of complete reporting, and explanations for each item of PRISMA-DTA for Abstracts.
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Affiliation(s)
- Jérémie F Cohen
- Department of Pediatrics and Inserm UMR 1153 (Centre of Research in Epidemiology and Statistics), Necker - Enfants Malades Hospital, Assistance Publique - Hôpitaux de Paris, Université de Paris, Paris, France
| | - Jonathan J Deeks
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
| | - Lotty Hooft
- Cochrane Netherlands, Julius Center for Health Sciences and Primary Care, Utrecht University, University Medical Center Utrecht, Utrecht, Netherlands
| | - Jean-Paul Salameh
- The Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, ON, Canada
- Faculty of Medicine, Queen's University, Kingston, ON, Canada
| | - Daniël A Korevaar
- Department of Respiratory Medicine, Academic Medical Centers, Amsterdam, Netherlands
| | | | - Sally Hopewell
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Harriet A Hunt
- Exeter Test Group, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Chris J Hyde
- Exeter Test Group, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Mariska M Leeflang
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam Public Health, Academic Medical Centers, Amsterdam, Netherlands
| | | | - Trevor A McGrath
- Department of Radiology, University of Ottawa, Ottawa, ON, Canada
| | - David Moher
- Centre for Journalology, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Johannes B Reitsma
- Cochrane Netherlands, Julius Center for Health Sciences and Primary Care, Utrecht University, University Medical Center Utrecht, Utrecht, Netherlands
| | - Anne W S Rutjes
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Yemisi Takwoingi
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
| | - Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Penny Whiting
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Brian H Willis
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Brett Thombs
- Lady Davis Institute of the Jewish General Hospital and Department of Psychiatry, McGill University, Montréal, QC, Canada
| | - Patrick M Bossuyt
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam Public Health, Academic Medical Centers, Amsterdam, Netherlands
| | - Matthew D F McInnes
- University of Ottawa, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
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Taormina G, Gopinath R, Moore J, Yasinskaya Y, Colangelo P, Reynolds K, Nambiar S. A Regulatory Review Approach for Evaluation of Micafungin for Treatment of Neonatal Candidiasis. Clin Infect Dis 2021; 73:2335-2340. [PMID: 33458754 DOI: 10.1093/cid/ciab025] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Indexed: 12/11/2022] Open
Abstract
Pathogenesis of neonatal candidiasis (NC) is distinct from systemic candidiasis in adults and older pediatric patients due to the significant incidence of central nervous system (CNS) involvement in neonates. Thus, although adequate and well-controlled trials in NC are often unfeasible due to difficulty enrolling patients, extrapolation of efficacy from antifungal drug trials in adults is generally not appropriate. However, treatment of NC is an area of great unmet need. We describe a regulatory review approach that combined the assessment of limited clinical efficacy, pharmacokinetics, and safety data from neonates and young infants along with microbiology outcomes and pharmacokinetic data from relevant nonclinical models of candidemia/invasive candidiasis to inform the use of micafungin in pediatric patients younger than 4 months of age, while communicating areas of remaining uncertainty in labeling.
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Affiliation(s)
- Gillian Taormina
- Division of Anti-Infectives, Office of Infectious Diseases, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD
| | - Ramya Gopinath
- Division of Anti-Infectives, Office of Infectious Diseases, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD
| | - Jason Moore
- Division of Infectious Disease Pharmacology, Office of Clinical Pharmacology, Office of Translational Sciences, Food and Drug Administration, Silver Spring, MD
| | - Yuliya Yasinskaya
- Division of Anti-Infectives, Office of Infectious Diseases, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD
| | - Philip Colangelo
- Division of Infectious Disease Pharmacology, Office of Clinical Pharmacology, Office of Translational Sciences, Food and Drug Administration, Silver Spring, MD
| | - Kellie Reynolds
- Division of Infectious Disease Pharmacology, Office of Clinical Pharmacology, Office of Translational Sciences, Food and Drug Administration, Silver Spring, MD
| | - Sumati Nambiar
- Division of Anti-Infectives, Office of Infectious Diseases, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD
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Cliquennois P, Scherdel P, Lavergne R, Flamant C, Morio F, Cohen JF, Launay E, Gras Le Guen C. Serum (1 → 3)-β-D-glucan could be useful to rule out invasive candidiasis in neonates with an adapted cut-off. Acta Paediatr 2021; 110:79-84. [PMID: 32304593 DOI: 10.1111/apa.15321] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 04/07/2020] [Accepted: 04/16/2020] [Indexed: 01/05/2023]
Abstract
AIM We assessed the diagnostic accuracy of serum (1 → 3)-β-D-glucan (BDG) for neonatal invasive candidiasis (NIC) using the recommended cut-off usually used in adults for detecting invasive candidiasis and searched for an optimal cut-off for ruling out NIC. METHODS We conducted a prospective cross-sectional study at Nantes University medical centre from January 2017 to July 2018. All consecutive newborn infants of less than 28 days of corrected age, with clinically suspected NIC, who underwent BDG assay, were included. Sensitivity and specificity were calculated by using the recommended cut-off of 80 pg/mL. Receiver operating characteristic curve analysis was used to identify an optimal cut-off value. RESULTS We included 55 newborn infants with 61 episodes of suspected NIC. Their median gestational and chronological ages were 28.0 weeks (interquartile range [IQR] 26.4-34.1) and 10.0 days (IQR 6.0-22.0), respectively. Of 61 episodes, seven revealed NIC. Sensitivity and specificity were 85.7% (95% confidence interval [CI] 42.1%-99.6%) and 51.9% (37.8%-65.7%) with the recommended cut-off, respectively. An optimal cut-off of 174 pg/mL offered the same sensitivity but higher specificity 77.8% (64.4%-88.0%). CONCLUSION The recommended cut-off of 80 pg/mL was probably too low for ruling out NIC. A higher cut-off might have been more appropriate.
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Affiliation(s)
| | - Pauline Scherdel
- Clinical Investigation Center (CIC004) University Hospital of Nantes Nantes France
- Inserm UMR 1153 Obstetrical Perinatal and Pediatric Epidemiology Research Team (Epopé) Center of Research in Epidemiology and Statistics (CRESS) University of Paris Paris France
| | - Rose‐Anne Lavergne
- Parasitology and Mycology Laboratory Institute of Biology University Hospital of Nantes Nantes France
| | - Cyril Flamant
- Neonatal Intensive Care Unit University Hospital of Nantes Nantes France
| | - Florent Morio
- Parasitology and Mycology Laboratory Institute of Biology University Hospital of Nantes Nantes France
| | - Jeremie F. Cohen
- Inserm UMR 1153 Obstetrical Perinatal and Pediatric Epidemiology Research Team (Epopé) Center of Research in Epidemiology and Statistics (CRESS) University of Paris Paris France
- Department of General Pediatrics and Pediatric Infectious Diseases Necker Hospital for Sick Children APHP University of Paris Paris France
| | - Elise Launay
- Clinical Investigation Center (CIC004) University Hospital of Nantes Nantes France
- Pediatric and Emergency Department University Hospital of Nantes Nantes France
| | - Christele Gras Le Guen
- Clinical Investigation Center (CIC004) University Hospital of Nantes Nantes France
- Pediatric and Emergency Department University Hospital of Nantes Nantes France
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Ahamefula Osibe D, Lei S, Wang B, Jin C, Fang W. Cell wall polysaccharides from pathogenic fungi for diagnosis of fungal infectious disease. Mycoses 2020; 63:644-652. [PMID: 32401381 DOI: 10.1111/myc.13101] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 04/12/2020] [Accepted: 05/04/2020] [Indexed: 12/12/2022]
Abstract
Invasive fungal diseases are associated with significant morbidity and mortality, particularly in immunocompromised individuals. Early and accurate diagnosis is crucial for effective treatment. Despite traditional methods such as microbiological culture, histopathology, radiology and direct microscopy are available, antigen/antibody-based diagnostics are emerging for diagnosis of invasive fungal infections (IFI). Fungal cell wall is a unique structure composed of polysaccharides that are well correlated with fungal burden during fungal infections. Based on this feature, cell wall polysaccharides have been explored as antigens in IFIs diagnostics such as the galactomannan assay, mannan test, β-glucan assay and cryptococcal CrAg test. Herein, we provide an overview on the cell wall polysaccharides from three opportunistic pathogens: Aspergillus fumigatus, Candida albicans and Cryptococcus neoformans, and their applications for IFIs diagnosis. The clinical outcome of newly developed cell wall polysaccharides-based diagnostics is also discussed.
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Affiliation(s)
- Dandy Ahamefula Osibe
- State Key Laboratory of Non-Food Biomass and Enzyme Technology, National Engineering Research Center for Non-Food Biorefinery, Guangxi Academy of Sciences, Nanning, China.,College of Life Science and Technology, Guangxi University, Nanning, China.,Department of Plant Science & Biotechnology, University of Nigeria, Nsukka, Nigeria
| | - Shuhan Lei
- State Key Laboratory of Non-Food Biomass and Enzyme Technology, National Engineering Research Center for Non-Food Biorefinery, Guangxi Academy of Sciences, Nanning, China.,College of Life Science and Technology, Guangxi University, Nanning, China
| | - Bin Wang
- State Key Laboratory of Non-Food Biomass and Enzyme Technology, National Engineering Research Center for Non-Food Biorefinery, Guangxi Academy of Sciences, Nanning, China
| | - Cheng Jin
- State Key Laboratory of Non-Food Biomass and Enzyme Technology, National Engineering Research Center for Non-Food Biorefinery, Guangxi Academy of Sciences, Nanning, China.,College of Life Science and Technology, Guangxi University, Nanning, China
| | - Wenxia Fang
- State Key Laboratory of Non-Food Biomass and Enzyme Technology, National Engineering Research Center for Non-Food Biorefinery, Guangxi Academy of Sciences, Nanning, China
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