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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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2
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Walsh TJ, Zhang SX. Emerging Roles of (1→3)-β-D-Glucan in Cerebrospinal Fluid for Detection and Therapeutic Monitoring of Invasive Fungal Diseases of the Central Nervous System. Clin Infect Dis 2024; 78:11-14. [PMID: 37650506 DOI: 10.1093/cid/ciad520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 08/25/2023] [Indexed: 09/01/2023] Open
Affiliation(s)
- Thomas J Walsh
- Center for Innovative Therapeutics and Diagnostics, Richmond, Virginia, USA
- University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Sean X Zhang
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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3
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Bigot J, Leroy J, Chouaki T, Cholley L, Bigé N, Tabone MD, Brissot E, Thorez S, Maizel J, Dupont H, Sendid B, Hennequin C, Guitard J. ß-D-Glucan Assay in the Cerebrospinal Fluid for the Diagnosis of Non-cryptococcal Fungal Infection of the Central Nervous System: A Retrospective Multicentric Analysis and a Comprehensive Review of the Literature. Clin Infect Dis 2023; 77:711-720. [PMID: 37132362 DOI: 10.1093/cid/ciad274] [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: 11/08/2022] [Revised: 04/21/2023] [Accepted: 05/02/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND Except for cryptococcosis, fungal infection of the central nervous system (FI-CNS) is a rare but severe complication. Clinical and radiological signs are non-specific, and the value of conventional mycological diagnosis is very low. This study aimed to assess the value of β1,3-D-glucan (BDG) detection in the cerebrospinal fluid (CSF) of non-neonatal non-cryptococcosis patients. METHODS Cases associated with BDG assay in the CSF performed in 3 French University Hospitals over 5 years were included. Clinical, radiological, and mycological results were used to classify the episodes as proven/highly probable, probable, excluded, and unclassified FI-CNS. Sensitivity and specificity were compared to that calculated from an exhaustive review of the literature. RESULTS In total, 228 episodes consisting of 4, 7, 177, and 40 proven/highly probable, probable, excluded, and unclassified FI-CNS, respectively, were analysed. The sensitivity of BDG assay in CSF to diagnose proven/highly probable/probable FI-CNS ranged from 72.7% [95% confidence interval {CI}: 43.4%‒90.2%] to 100% [95% CI: 51%‒100%] in our study and was 82% in the literature. For the first time, specificity could be calculated over a large panel of pertinent controls and was found at 81.8% [95% CI: 75.3%‒86.8%]. Bacterial neurologic infections were associated with several false positive results. CONCLUSIONS Despite its sub-optimal performance, BDG assay in the CSF should be added to the diagnostic armamentarium for FI-CNS.
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Affiliation(s)
- Jeanne Bigot
- Sorbonne Université, Inserm, Centre de Recherche Saint-Antoine, CRSA, AP-HP, Hôpital Saint-Antoine, Service de Parasitologie-Mycologie, Paris, France
| | - Jordan Leroy
- CHU Lille, Laboratoire de Parasitologie-Mycologie, Univ. Lille, Glycobiology in Fungal Pathogenesis & Clinical Applications, Inserm U1285, CNRS, UMR 8576-UGSF-Unité de Glycobiologie Structurale et Fonctionnelle, Lille, France
| | - Taieb Chouaki
- Mycology Laboratory, University Hospital of Amiens, Amiens, France
| | - Laurence Cholley
- Sorbonne Université, APHP, Hôpital Saint Antoine, Service de Radiologie Générale, Paris, France
| | - Naïke Bigé
- Sorbonne Université, APHP, Hôpital Saint Antoine, Service de Réanimation Médicale, Paris, France
- Department of Intensive Care, Gustave Roussy Cancer Campus, Villejuif, France
| | - Marie-Dominique Tabone
- Département d'Hématologie et d'Oncologie Pédiatrique, Sorbonne Université, APHP, Hôpital Armand Trousseau, Paris, France
| | - Eolia Brissot
- Sorbonne Université, INSERM U938, APHP, Hôpital Saint Antoine, Service d'Hématologie et Thérapie Cellulaire, Paris, France
| | - Sophie Thorez
- Sorbonne Université, APHP, Hôpital St Antoine, Service de Parasitologie-Mycologie, Paris, France
| | - Julien Maizel
- Médecine Intensive Réanimation, Centre Hospitalier Universitaire Amiens-Picardie, Amiens, France
| | - Hervé Dupont
- Department of Anesthesiology and Critical Care Medicine, Surgical ICU, University Hospital of Amiens Picardy, Amiens, France
- Université de Picardie Jules Verne, Unité de recherche 7518 SSPC, CHU Amiens Picardie, Service d'Anesthésie et de Réanimation Polyvalente, Amiens, France
| | - Boualem Sendid
- CHU Lille, Laboratoire de Parasitologie-Mycologie, Univ. Lille, Glycobiology in Fungal Pathogenesis & Clinical Applications, Inserm U1285, CNRS, UMR 8576-UGSF-Unité de Glycobiologie Structurale et Fonctionnelle, Lille, France
| | - Christophe Hennequin
- Sorbonne Université, Inserm, Centre de Recherche Saint-Antoine, CRSA, AP-HP, Hôpital Saint-Antoine, Service de Parasitologie-Mycologie, Paris, France
| | - Juliette Guitard
- Sorbonne Université, Inserm, Centre de Recherche Saint-Antoine, CRSA, AP-HP, Hôpital Saint-Antoine, Service de Parasitologie-Mycologie, Paris, France
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Brain abscess caused by Scedosporium boydii in a systemic lupus erythematosus patient: A case report and literature review. Indian J Med Microbiol 2022; 40:611-615. [PMID: 35864047 DOI: 10.1016/j.ijmmb.2022.06.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 04/25/2022] [Accepted: 06/25/2022] [Indexed: 11/22/2022]
Abstract
Scedosporium boydii is considered as emerging opportunists affecting both immunocompromised and immunocompetent individuals. Diagnosis and treatment of Scedosporium infections can be challenging, and the outcome is frequently fatal, especially in patients with disseminated infections. Metagenomic next-generation sequencing (mNGS) is a promising adjunctive diagnostic approach for uncommon pathogens. Here, we report a rare case of brain abscess caused by S. boydii in a systemic lupus erythematosus (SLE) patient. This case highlights the importance of mNGS in the early diagnosis of S. boydii. Additionally, the combined application of culture and molecular tools may be promising in the clinical diagnosis of fungal disease.
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5
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Barbolini L, Riat A, Van Delden C, Schrenzel J. Caution when using 1,3, β-D-glucan in the CSF as a biomarker of Candida albicans meningitis. Int J Infect Dis 2022; 122:531-533. [PMID: 35760379 DOI: 10.1016/j.ijid.2022.06.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 06/09/2022] [Accepted: 06/21/2022] [Indexed: 10/17/2022] Open
Abstract
Relying on a biomarker to diagnose or follow-up the treatment of a Candida albicans meningitis would have an impact on patient management. The biomarker 1,3, β-D-glucan (BDG), developed for serum testing, shows inconsistent values when applied on cerebro-spinal fluid (CSF), and its use with the current protocol on CSF samples warrants caution.
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Affiliation(s)
- Laura Barbolini
- Internal Medicine Division, Dept of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Arnaud Riat
- Bacteriology Laboratory, Dept of Diagnostics, Geneva University Hospitals, Geneva, Switzerland.
| | - Christian Van Delden
- Infectious Diseases Division, Dept of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Jacques Schrenzel
- Bacteriology Laboratory, Dept of Diagnostics, Geneva University Hospitals, Geneva, Switzerland; Infectious Diseases Division, Dept of Medicine, Geneva University Hospitals, Geneva, Switzerland
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Isavuconazole Treatment of Spinal Cord Invasive Aspergillosis Guided by Cerebrospinal Fluid (1,3)-β-d-Glucan Levels in a Patient with Low Interferon-Gamma and Ulcerative Colitis. J Fungi (Basel) 2022; 8:jof8060557. [PMID: 35736040 PMCID: PMC9224947 DOI: 10.3390/jof8060557] [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: 05/01/2022] [Revised: 05/22/2022] [Accepted: 05/24/2022] [Indexed: 02/04/2023] Open
Abstract
This case highlights the use of (1,3)-beta-d glucan to direct treatment of a cervical spinal cord Aspergillus fumigatus infection in a 22-year-old woman immunocompromised due to steroid and anti-TNF therapy in the context of ulcerative colitis and interferon gamma deficiency. A 4-year treatment course requiring neurosurgical intervention on four occasions and prolonged antifungal therapy, including isavuconazole, resulted in clinical cure with a corresponding decrease in CSF beta-d-glucan to <30 pg/mL. Serum and CSF galactomannan levels were not elevated at any point during the clinical course.
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7
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Forster J, Hoenigl M, Suerbaum S, Wagener J, Dichtl K. Serologic biomarkers in Candida and Aspergillus infections of the central nervous system: a comparison of galactomannan, mannan, and β-1,3-D-gucan testing from serum and cerebrospinal fluid. Mycoses 2022; 65:709-714. [PMID: 35506957 DOI: 10.1111/myc.13451] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/26/2022] [Accepted: 04/28/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The incidence of Aspergillus and Candida CNS infection, which are characterized by high mortality rates, is underestimated. This underdiagnosis presumably results from the limitations of available diagnostic tools and the need for invasive sampling. Little is known about the role of serologic biomarkers in the setting of CNS aspergillosis and candidiasis. PATIENTS, MATERIALS, METHODS Serum (19) and cerebrospinal fluid (CSF; 10) samples of 19 patients, whose CNS specimens yielded growth of Aspergillus or Candida, were analyzed for different biomarkers for fungal infection, i.e., galactomannan (GM), galactomannoprotein (GP), mannan, anti-mannan-antibodies, and β-1,3-D-glucan (BDG). Serum and CSF specimens of time-matched patients (two each for every case of fungal CNS infection) were included as controls. RESULTS GM, GP, and BDG seropositivity was found in one, two, and three of five cases of CNS aspergillosis. BDG and mannan / anti-mannan-antibody sensitivity in proven CNS candidiasis was 40 % and 20 %, respectively. Applying the serum cut off, sensitivity in CSF testing was 100 % for GM and BDG, and 50 % for mannans. While serum specificity for all assays ranged from 89 - 97 %, specificity for CSF BDG was only 70 %. No false positive GM results from CSF were obtained. CONCLUSION Sensitivity for diagnosing CNS aspergillosis and CNS candidiasis from serum is mediocre for all serological biomarkers. GM testing in CSF proved excellent performance. With a sensitivity of 100 % but a specificity of only 70 %, CSF BDG might be most useful when used in patients with a high pre-test probability.
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Affiliation(s)
- Johannes Forster
- Institut für Hygiene und Mikrobiologie, Julius-Maximilians-Universität Würzburg, Würzburg, Germany
| | - Martin Hoenigl
- Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz, Graz, Austria.,Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, United States
| | - Sebastian Suerbaum
- Max von Pettenkofer-Institut für Hygiene und Medizinische Mikrobiologie, Medizinische Fakultät, LMU München, Munich, Germany
| | - Johannes Wagener
- Institut für Hygiene und Mikrobiologie, Julius-Maximilians-Universität Würzburg, Würzburg, Germany.,Department of Clinical Microbiology, St. James's Hospital, Dublin, Ireland.,Department of Clinical Microbiology, School of Medicine, Trinity College Dublin, The University of Dublin, St. James's Hospital Campus, Dublin, Ireland
| | - Karl Dichtl
- Max von Pettenkofer-Institut für Hygiene und Medizinische Mikrobiologie, Medizinische Fakultät, LMU München, Munich, Germany.,Diagnostic and Research Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Austria
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8
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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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9
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Hobson CA, Desoubeaux G, Carvalho-Schneider C, Destrieux C, Cottier JP, Garot D, Le Brun C, Maakaroun Z, Lemaignen A, Bailly É, Bernard L. Challenging diagnosis of chronic cerebral fungal infection: Value of (1→3)-ß-D-glucan and mannan antigen testing in cerebrospinal fluid and of cerebral ventricle puncture. Med Mycol 2021; 59:74-80. [PMID: 32470986 DOI: 10.1093/mmy/myaa035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 04/09/2020] [Accepted: 04/27/2020] [Indexed: 12/14/2022] Open
Abstract
Primary fungal infection of the central nervous system (CNS) is rare but often associated with severe prognosis. Diagnosis is complicated since cerebrospinal fluid (CSF) samples obtained from lumbar puncture usually remain sterile. Testing for fungal antigens in CSF could be a complementary diagnostic tool. We conducted such measurements in CSF from patients with CNS fungal infection and now discuss the usefulness of ventricular puncture. Mannan and (1→3)ß-D-glucan (BDG) testing were retrospectively performed in CSF samples from three patients with proven chronic CNS fungal infection (excluding Cryptococcus), and subsequently compared to 16 controls. Results from lumbar punctures and those from cerebral ventricles were confronted. BDG detection was positive in all the CSF samples (from lumbar and/or ventricular puncture) from the three confirmed cases. In case of Candida infection, mannan antigen measurement was positive in 75% of the CSF samples. In the control group, all antigen detections were negative (n = 15), except for one false positive. Faced with suspected chronic CNS fungal infection, measurement of BDG levels appears to be a complementary diagnostic tool to circumvent the limitations of mycological cultures from lumbar punctures. In the event of negative results, more invasive procedures should be considered, such as ventricular puncture.
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Affiliation(s)
- Claire A Hobson
- Department of Infectious Diseases, University Hospital of Tours, France
| | - Guillaume Desoubeaux
- Department of Parasitology and Mycology, University Hospital of Tours, France.,CEPR INSERM U1100 / Team 3
| | | | - Christophe Destrieux
- Department of Neuro-surgery, University Hospital of Tours, France.,UMR1253, iBrain, INSERM, Tours, France
| | - Jean-Philippe Cottier
- UMR1253, iBrain, INSERM, Tours, France.,Department of Neuro-imaging, University Hospital of Tours, France
| | - Denis Garot
- Intensive Care Unit, University Hospital of Tours, France
| | - Cécile Le Brun
- Department of Microbiology, University Hospital of Tours, France
| | - Zoha Maakaroun
- Department of Infectious Diseases, University Hospital of Tours, France
| | - Adrien Lemaignen
- Department of Infectious Diseases, University Hospital of Tours, France
| | - Éric Bailly
- Department of Parasitology and Mycology, University Hospital of Tours, France
| | - Louis Bernard
- Department of Infectious Diseases, University Hospital of Tours, France
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10
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Luckowitsch M, Rudolph H, Bochennek K, Porto L, Lehrnbecher T. Central Nervous System Mold Infections in Children with Hematological Malignancies: Advances in Diagnosis and Treatment. J Fungi (Basel) 2021; 7:168. [PMID: 33652605 PMCID: PMC7996787 DOI: 10.3390/jof7030168] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 02/21/2021] [Accepted: 02/22/2021] [Indexed: 12/11/2022] Open
Abstract
The incidence of invasive mold disease (IMD) has significantly increased over the last decades, and IMD of the central nervous system (CNS) is a particularly severe form of this infection. Solid data on the incidence of CNS IMD in the pediatric setting are lacking, in which Aspergillus spp. is the most prevalent pathogen, followed by mucorales. CNS IMD is difficult to diagnose, and although imaging tools such as magnetic resonance imaging have considerably improved, these techniques are still unspecific. As microscopy and culture have a low sensitivity, non-culture-based assays such as the detection of fungal antigens (e.g., galactomannan or beta-D-glucan) or the detection of fungal nucleic acids by molecular assays need to be validated in children with suspected CNS IMD. New and potent antifungal compounds helped to improve outcome of CNS IMD, but not all agents are approved for children and a pediatric dosage has not been established. Therefore, studies have to rapidly evaluate dosage, safety and efficacy of antifungal compounds in the pediatric setting. This review will summarize the current knowledge on diagnostic tools and on the management of CNS IMD with a focus on pediatric patients.
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Affiliation(s)
- Marie Luckowitsch
- Division of Pediatric Hematology and Oncology, Hospital for Children and Adolescents, University Hospital Frankfurt, Goethe University, 60590 Frankfurt am Main, Germany; (M.L.); (H.R.); (K.B.)
| | - Henriette Rudolph
- Division of Pediatric Hematology and Oncology, Hospital for Children and Adolescents, University Hospital Frankfurt, Goethe University, 60590 Frankfurt am Main, Germany; (M.L.); (H.R.); (K.B.)
| | - Konrad Bochennek
- Division of Pediatric Hematology and Oncology, Hospital for Children and Adolescents, University Hospital Frankfurt, Goethe University, 60590 Frankfurt am Main, Germany; (M.L.); (H.R.); (K.B.)
| | - Luciana Porto
- Institute for Neuroradiology, University Hospital Frankfurt, Goethe University, 60590 Frankfurt am Main, Germany;
| | - Thomas Lehrnbecher
- Division of Pediatric Hematology and Oncology, Hospital for Children and Adolescents, University Hospital Frankfurt, Goethe University, 60590 Frankfurt am Main, Germany; (M.L.); (H.R.); (K.B.)
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11
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Manso CF, Bibby DF, Mohamed H, Brown DWG, Zuckerman M, Mbisa JL. Enhanced Detection of DNA Viruses in the Cerebrospinal Fluid of Encephalitis Patients Using Metagenomic Next-Generation Sequencing. Front Microbiol 2020; 11:1879. [PMID: 32903437 PMCID: PMC7435129 DOI: 10.3389/fmicb.2020.01879] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 07/16/2020] [Indexed: 12/16/2022] Open
Abstract
The long and expanding list of viral pathogens associated with causing encephalitis confounds current diagnostic procedures, and in up to 50% of cases, the etiology remains undetermined. Sequence-agnostic metagenomic next-generation sequencing (mNGS) obviates the need to specify targets in advance and thus has great potential in encephalitis diagnostics. However, the low relative abundance of viral nucleic acids in clinical specimens poses a significant challenge. Our protocol employs two novel techniques to selectively remove human material at two stages, significantly increasing the representation of viral material. Our bioinformatic workflow using open source protein- and nucleotide sequence-matching software balances sensitivity and specificity in diagnosing and characterizing any DNA viruses present. A panel of 12 cerebrospinal fluid (CSFs) from encephalitis cases was retrospectively interrogated by mNGS, with concordant results in seven of nine samples with a definitive DNA virus diagnosis, and a different herpesvirus was identified in the other two. In two samples with an inconclusive diagnosis, DNA viruses were detected and in a virus-negative sample, no viruses were detected. This assay has the potential to detect DNA virus infections in cases of encephalitis of unknown etiology and to improve the current screening tests by identifying new and emerging agents.
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Affiliation(s)
- Carmen F Manso
- Virus Reference Department, Public Health England, London, United Kingdom
| | - David F Bibby
- Virus Reference Department, Public Health England, London, United Kingdom
| | - Hodan Mohamed
- Virus Reference Department, Public Health England, London, United Kingdom
| | - David W G Brown
- Virus Reference Department, Public Health England, London, United Kingdom.,Laboratorio de Virus Respiratorios e do Sarampo, Instituto Oswaldo Cruz/Fiocruz, Rio de Janeiro, Brazil
| | - Mark Zuckerman
- South London Specialist Virology Centre, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Jean L Mbisa
- Virus Reference Department, Public Health England, London, United Kingdom
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12
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Abstract
PURPOSE OF REVIEW We review the performance of culture-independent diagnostic tests (CIDTs), including β-D-glucan (BDG), polymerase chain reaction (PCR) and T2Candida, in diagnosing invasive candidiasis, their potential roles in patient management, and unintended consequences of testing. RECENT FINDINGS In a recent multicenter trial, T2Candida was 90% sensitive and 98% specific for diagnosing candidemia. A new study provided the first data for T2Candida in diagnosing deep-seated candidiasis, demonstrating sensitivity/specificity of 45%/96%. Two studies showed that ongoing T2Candida-positivity is associated with poor prognosis. In several studies, serum BDG and T2Candida, targeted to patients at-risk for invasive candidiasis, were useful in guiding treatment decisions and antifungal stewardship. A randomized, multicenter trial of BDG-guided empiric antifungal treatment is underway among critically ill patients. PCR performance was highly variable for candidemia and deep-seated candidiasis in recent studies. CIDT results may overstate bloodstream infections, according to current National Healthcare Safety Network (NHSN) definitions. SUMMARY BDG and T2Candida are nearing prime-time status in the clinic. To be useful, testing must be directed to carefully chosen patients and specific clinical questions. Candida PCR is limited by a need for standardized methodologies and commercial assays. NHSN definitions of bloodstream infections must be revised in the era of CIDTs.
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13
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Abstract
Appropriate diagnosis of invasive fungal infections (IFIs) is critical due to the high rates of morbidity and mortality, as well as the substantial economic burden, associated with the management of these diseases. The recognition of IFI and differentiation from other infections with similar clinical presentations can be challenging, which can lead to diagnostic error that not only has an impact on individual patient health outcomes but also on antimicrobial drug usage and the growing threat of antimicrobial resistance in bacteria. Therefore, there is a significant need for improved stewardship related to diagnostic testing for and treatment of IFIs. The purpose of this review is to highlight recent advances related to current fungal diagnostics, as well as explore some of the most innovative technology that has emerged with the potential to shift the paradigm of clinical mycology. In general, this review will discuss research related to enhanced fungal culture utilization and identification techniques, expanded applications of fungal antigen testing, and recently developed molecular assays and other novel nonculture fungal diagnostic approaches. Specifically, the application of mass spectrometry, novel glycobiomarker detection, and detection of fungal-specific volatile organic compounds will be reviewed, along with other key updates, to provide the reader with an updated review that extends beyond the basics of IFI laboratory diagnostics. Where appropriate, the reader will be directed to more comprehensive reviews of certain aspects of clinical mycology laboratory testing to provide a broader context for the critical consideration of these updates.
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Efficacy of Cerebrospinal Fluid Beta-d-Glucan Diagnostic Testing for Fungal Meningitis: a Systematic Review. J Clin Microbiol 2020; 58:JCM.02094-19. [PMID: 31996446 DOI: 10.1128/jcm.02094-19] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 01/25/2020] [Indexed: 12/15/2022] Open
Abstract
Several case reports and cohort studies have examined the use of (1,3)-beta-d-glucan measurement with cerebrospinal fluid to diagnose fungal meningitis. This systematic review aims to characterize the evidence regarding cerebrospinal fluid (1,3)-beta-d-glucan measurement to detect fungal meningitis. We searched PubMed for (1,3)-beta-d-glucan and each of several distinct fungi, cerebrospinal fluid, and meningitis. Summary data including diagnostic performance (where applicable) were recorded. A total of 939 records were examined via a PubMed search. One hundred eighteen records remained after duplicates were removed, and 104 records were excluded, as they did not examine cerebrospinal fluid, included animals, or focused on nonfungal infections. Fourteen studies were included in this systematic review. A variety of fungi, including species of Candida, Aspergillus, Exserohilum, Cryptococcus, Histoplasma, and Coccidioides, were studied, although most were case reports. Diagnostic accuracy was examined in 5 studies. Cerebrospinal fluid (CSF) (1,3)-beta-d-glucan measurement showed >95% sensitivity in the corticosteroid injection-related outbreak of Exserohilum rostratum One study in Histoplasma meningitis found 53% (53/87) sensitivity and 87% (133/153) specificity, while another study of Cryptococcus meningitis found 89% (69/78) sensitivity and 85% (33/39) specificity. CSF (1,3)-beta-d-glucan testing may be useful, primarily as a nonspecific marker of fungal meningitis. Although the FDA black box warning states that Cryptococcus spp. do not make (1,3)-beta-d-glucan, the current evidence shows that (1,3)-beta-d-glucan is detectable in cryptococcal meningitis. Organism-specific testing should be used in conjunction with (1,3)-beta-d-glucan measurement.
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Abstract
Infections of the central nervous system cause significant morbidity and mortality in immunocompetent and immunocompromised individuals. A wide variety of microorganisms can cause infections, including bacteria, mycobacteria, fungi, viruses, and parasites. Although less invasive testing is preferred, surgical biopsy may be necessary to collect diagnostic tissue. Histologic findings, including special stains and immunohistochemistry, can provide a morphologic diagnosis in many cases, which can be further classified by molecular testing. Correlation of molecular, culture, and other laboratory results with histologic findings is essential for an accurate diagnosis, and to minimize false positives from microbial contamination.
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Affiliation(s)
- Isaac H Solomon
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
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16
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Abstract
PURPOSE OF REVIEW This article describes the clinical presentation, diagnostic approach (including the use of novel diagnostic platforms), and treatment of select infectious and noninfectious etiologies of chronic meningitis. RECENT FINDINGS Identification of the etiology of chronic meningitis remains challenging, with no cause identified in at least one-third of cases. Often, several serologic, CSF, and neuroimaging studies are indicated, although novel diagnostic platforms including metagenomic deep sequencing may hold promise for identifying organisms. Infectious etiologies are more common in those at risk for disseminated disease, specifically those who are immunocompromised because of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), transplantation, or immunosuppressant medications. An important step in identifying the etiology of chronic meningitis is assembling a multidisciplinary team of individuals, including those with specialized expertise in ophthalmology, dermatology, rheumatology, and infectious diseases, to provide guidance regarding diagnostic procedures. SUMMARY Chronic meningitis is defined as inflammation involving the meninges that lasts at least 4 weeks and is associated with a CSF pleocytosis. Chronic meningitis has numerous possible infectious and noninfectious etiologies, making it challenging to definitively diagnose patients. Therefore, a multifaceted approach that combines history, physical examination, neuroimaging, and laboratory analysis, including novel diagnostic platforms, is needed. This article focuses on key aspects of the evaluation of and approach to patients with chronic meningitis. Specific infectious etiologies and differential diagnoses of subacute and chronic meningitis, including noninfectious etiologies, are addressed.
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Central Nervous System Infections Due to Aspergillus and Other Hyaline Molds. J Fungi (Basel) 2019; 5:jof5030079. [PMID: 31480311 PMCID: PMC6787746 DOI: 10.3390/jof5030079] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 08/23/2019] [Accepted: 08/27/2019] [Indexed: 02/06/2023] Open
Abstract
Central nervous system infections due to Aspergillus spp and other hyaline molds such as Fusarium and Scedosporium spp are rare but fatal conditions. Invasion of the central nervous system (CNS) tends to occur as a result of hematogenous dissemination among immunocompromised patients, and by local extension or direct inoculation secondary to trauma in immunocompetent hosts. Efforts should be directed to confirm the diagnosis by image-guided stereotactic brain biopsy when feasible. Non-culture methods could be useful to support the diagnosis, but they have not been validated to be performed in cerebral spinal fluid. Treatment of these infections is challenging given the variable susceptibility profile of these pathogens and the penetration of antifungal agents into the brain.
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Pacora P, Romero R, Erez O, Maymon E, Panaitescu B, Kusanovic JP, Tarca AL, Hsu CD, Hassan SS. The diagnostic performance of the beta-glucan assay in the detection of intra-amniotic infection with Candida species. J Matern Fetal Neonatal Med 2019; 32:1703-1720. [PMID: 29226760 PMCID: PMC6021224 DOI: 10.1080/14767058.2017.1416083] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 12/07/2017] [Indexed: 01/08/2023]
Abstract
INTRODUCTION A bioassay based on the detection of beta-glucan, a constituent of the cell wall of fungi, has been successfully used to diagnose fungal infections in a variety of biological fluids but not yet in the amniotic fluid. OBJECTIVE To determine the diagnostic performance of a beta-glucan bioassay in the detection of Candida species in the amniotic fluid of women who either did or did not have an intrauterine contraceptive device (IUD) in place during an episode of spontaneous preterm parturition. METHODS The study population comprised women who had a singleton pregnancy without congenital or chromosomal abnormalities, who experienced preterm labor or preterm prelabor rupture of the fetal membranes, and who underwent a transabdominal amniocentesis for clinical indications. Samples of amniotic fluid were cultured for aerobic and anaerobic bacteria, genital mycoplasmas, and Candida species, and assayed for beta-glucan, using the (1→3)-beta-d-glucan-specific Limulus amebocyte lysate test (beta-glucan assay) in all cases. Amniotic fluid interleukin (IL)-6 assay results were also available for all cases. The beta-glucan assay takes about 1 hour to run: a concentration >80 pg/mL was considered positive for fungi. Sterile intra-amniotic inflammation of the amniotic cavity was defined by the presence of an amniotic fluid IL-6 concentration ≥2.6 ng/mL and a negative amniotic fluid culture. RESULTS (1) One hundred ninety-seven (197) women met the study criteria, of whom 58 (29.4%) had an IUD in place; (2) 20 (10.2%) women had a culture of proven intra-amniotic Candida species-related infection, 19 of whom had a positive beta-glucan assay [sensitivity, 95% (19/20; 95% confidence interval (CI): 75.1-99.9%)]; and (3) the specificity of the beta-glucan assay was 75.1% [133/177; 95% CI: 68.1-99.9%]. It was affected by the presence of nonfungal intra-amniotic infections and an IUD, but not by the presence of sterile intra-amniotic inflammation, and there was a significant interaction between the presence of an IUD and nonfungal intra-amniotic infections (estimated for the interaction effect = 2.1923, p value =.026). The assay's specificity was reduced when nonfungal intra-amniotic infections were diagnosed but only in women who did not have an IUD. Among women without an IUD, the assay's specificity was 91.4% (117/128); it was 93% (106/114) for those without intra-amniotic infection, and 78.6% (11/14) for those with a nonfungal intra-amniotic infection; the difference was not significant (p = .09). Among women with an IUD, the assay's specificity was 32.7% (16/49); 42.9% (9/21) for those with a nonfungal intra-amniotic infection; and 25% (7/28) for those without intra-amniotic infection; and the difference was significant (p = .03). CONCLUSIONS The beta-glucan assay is a sensitive, rapid, point-of-care test used to diagnose intra-amniotic Candida species-related infection, and it has a high specificity in pregnant women who did not have an IUD in place.
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Affiliation(s)
- Percy Pacora
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Roberto Romero
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan, USA
- Center for Molecular Medicine and Genetics, Wayne State University, Detroit, Michigan, USA
| | - Offer Erez
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Eli Maymon
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Bogdan Panaitescu
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Juan Pedro Kusanovic
- Center for Research and Innovation in Maternal-Fetal Medicine (CIMAF), Department of Obstetrics and Gynecology, Sótero del Río Hospital, Santiago, Chile
- Division of Obstetrics and Gynecology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Adi L. Tarca
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Chaur-Dong Hsu
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Sonia S. Hassan
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
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Use of Cerebrospinal Fluid (1,3)-β-d-Glucan to Monitor Treatment Response in Candida albicans Meningitis in an HIV-infected Patient. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2018. [DOI: 10.1097/ipc.0000000000000624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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20
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Abstract
Neuroinfectious diseases continue to cause morbidity and mortality worldwide, with many emerging or reemerging infections resulting in neurologic sequelae. Careful clinical evaluation coupled with appropriate laboratory investigations still forms the bedrock for making the correct etiologic diagnosis and implementing appropriate management. The treating physician needs to understand the individual test characteristics of each of the many conventional candidate-based diagnostics: culture, pathogen-specific polymerase chain reaction, antigen, antibody tests, used to diagnose the whole array of neuroinvasive infections. In addition, there is a growing need for more comprehensive, agnostic testing modalities that can identify a diversity of infections with a single assay.
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Affiliation(s)
- Prashanth S Ramachandran
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, 675 Nelson Rising Lane, NS212A, Campus Box 3206, San Francisco, CA 94158, USA
| | - Michael R Wilson
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, 675 Nelson Rising Lane, NS212A, Campus Box 3206, San Francisco, CA 94158, USA.
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Detection of (1,3)-β-d-Glucan in Cerebrospinal Fluid in Histoplasma Meningitis. J Clin Microbiol 2018; 56:JCM.00663-18. [PMID: 30021828 DOI: 10.1128/jcm.00663-18] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 07/05/2018] [Indexed: 11/20/2022] Open
Abstract
The diagnosis of central nervous system (CNS) histoplasmosis is often difficult. Although cerebrospinal fluid (CSF) (1,3)-β-d-glucan (BDG) is available as a biological marker for the diagnosis of fungal meningitis, there are limited data on its use for the diagnosis of Histoplasma meningitis. We evaluated CSF BDG detection, using the Fungitell assay, in patients with CNS histoplasmosis and controls. A total of 47 cases and 153 controls were identified. The control group included 13 patients with a CNS fungal infection other than histoplasmosis. Forty-nine percent of patients with CNS histoplasmosis and 43.8% of controls were immunocompromised. The median CSF BDG level was 85 pg/ml for cases, compared to <31 pg/ml for all controls (P < 0.05) and 82 pg/ml for controls with other causes of fungal meningitis (P = 0.27). The sensitivity for detection of BDG in CSF was 53.2%, whereas the specificity was 86.9% versus all controls and 46% versus other CNS fungal infections. CSF BDG levels of ≥80 pg/ml are neither sensitive nor specific to support a diagnosis of Histoplasma meningitis.
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Cornu M, Goudjil S, Kongolo G, Leke A, Poulain D, Chouaki T, Sendid B. Evaluation of the (1,3)-β-D-glucan assay for the diagnosis of neonatal invasive yeast infections. Med Mycol 2018; 56:78-87. [PMID: 28371838 DOI: 10.1093/mmy/myx021] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Accepted: 02/28/2017] [Indexed: 11/12/2022] Open
Abstract
Most newborns in the neonatal intensive care unit (NICU) are premature and at risk of invasive fungal infections (IFIs). Invasive yeast infections (IYIs) are the most common fungal infections in this population. These infections are difficult to diagnose because symptoms are nonspecific, and the sensitivity of blood cultures is low. The serum (1,3)-β-D-glucan (BDG) assay provides a reliable marker for the diagnosis of IFIs in adults with haematological malignancies. We assessed the diagnostic performance of this test in neonatal IYIs and its contribution to the monitoring of antifungal treatment. A retrospective study was performed in the NICU of the French University Hospital of Amiens from February 2012 to February 2014. Forty-seven neonates (33 males, 14 females) with a median gestational age of 30 weeks (IQR: 27-31) and median birth weight of 1200 g (IQR: 968-1700) were included and divided into three groups: 21 control neonates (CTRL), 20 neonates with probable IYI (PB), and six with proven IYI (PV). Median BDG levels were significantly higher in the global IYI group (PB + PV): 149 pg/ml (IQR: 85-364) vs. CTRL group: 39 pg/ml (IQR: 20-94) (P < .001). The optimal cut-off was 106 pg/ml (sensitivity 61.5%; specificity 81%). BDG levels decreased with antifungal treatment. BDG was detectable in cerebrospinal fluid, but the interest of this for diagnostic purposes remains unclear. Our results suggest that the BDG assay may be useful for the early identification of IYIs in neonates and for monitoring antifungal therapy efficacy.
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Affiliation(s)
- Marjorie Cornu
- Université de Lille, U995- LIRIC - Lille Inflammation Research International Centre, F-59000 Lille, France.,INSERM, U995, Fungal-Associated Invasive & Inflammatory Diseases, F-59000 Lille, France.,CHU Lille, Laboratoire de Parasitologie-Mycologie, F-59000 Lille, France
| | | | - Guy Kongolo
- CHU Amiens, Service de Néonatologie, Amiens, France
| | - André Leke
- CHU Amiens, Service de Néonatologie, Amiens, France
| | - Daniel Poulain
- Université de Lille, U995- LIRIC - Lille Inflammation Research International Centre, F-59000 Lille, France.,INSERM, U995, Fungal-Associated Invasive & Inflammatory Diseases, F-59000 Lille, France.,CHU Lille, Laboratoire de Parasitologie-Mycologie, F-59000 Lille, France.,CHU Amiens, Laboratoire de Parasitologie Mycologie, CHU, France
| | - Taieb Chouaki
- CHU Lille, Délégation à la Recherche Clinique et à l'Innovation, Lille, France
| | - Boualem Sendid
- Université de Lille, U995- LIRIC - Lille Inflammation Research International Centre, F-59000 Lille, France.,INSERM, U995, Fungal-Associated Invasive & Inflammatory Diseases, F-59000 Lille, France.,CHU Lille, Laboratoire de Parasitologie-Mycologie, F-59000 Lille, France
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Farhour Z, Mehraj V, Chen J, Ramendra R, Lu H, Routy JP. Use of (1→3)-β-d-glucan for diagnosis and management of invasive mycoses in HIV-infected patients. Mycoses 2018; 61:718-722. [PMID: 29855088 PMCID: PMC6175469 DOI: 10.1111/myc.12797] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 05/24/2018] [Accepted: 05/25/2018] [Indexed: 01/10/2023]
Abstract
People living with HIV (PLHIV) are highly vulnerable to invasive fungal infections (IFIs) due to their immune dysfunction. Diagnosis and treatment of IFIs remain challenging due to the requirement of deep tissue sampling to visualise and culture fungi before initiating treatment. Such techniques are less practical in resource‐limited settings due to their cost and requirement of relatively invasive procedures. Hence, identification of surrogate markers for the early diagnosis and therapeutic monitoring of IFIs is required. Recent studies have shown that (1→3)‐β‐d‐glucan (BDG), a major fungal cell wall antigen, represents a promising soluble marker for the presumptive diagnosis and therapeutic monitoring of IFIs in HIV‐infected patients. Herein, we review findings on the merits of BDG assays in the diagnosis of IFIs and monitoring of antifungal therapies for PLHIV. Conversely to other types of immunocompromised patients, HIV infection is associated with gut damage and subsequent bacterial and fungal translocation leading to elevated BDG plasma levels.
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Affiliation(s)
- Zahra Farhour
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada.,Research Institute, McGill University Health Centre, Montreal, QC, Canada
| | - Vikram Mehraj
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada.,Research Institute, McGill University Health Centre, Montreal, QC, Canada.,CR-CHUM, Université de Montréal, Montreal, QC, Canada
| | - Jun Chen
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada.,Research Institute, McGill University Health Centre, Montreal, QC, Canada.,Department of Infectious Diseases, Shanghai Public Health Clinical Center, Shanghai, China
| | - Rayoun Ramendra
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada.,Research Institute, McGill University Health Centre, Montreal, QC, Canada
| | - Hongzhou Lu
- Department of Infectious Diseases, Shanghai Public Health Clinical Center, Shanghai, China
| | - Jean-Pierre Routy
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada.,Research Institute, McGill University Health Centre, Montreal, QC, Canada.,Division of Hematology, McGill University Health Centre, Montreal, QC, Canada
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Giacobbe DR, Del Bono V, Viscoli C, Mikulska M. Use of 1,3-β-D-glucan in invasive fungal diseases in hematology patients. Expert Rev Anti Infect Ther 2017; 15:1101-1112. [PMID: 29125373 DOI: 10.1080/14787210.2017.1401467] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Invasive fungal diseases (IFD) remain a leading cause of morbidity and mortality in hematology patients. Within a diagnostic-driven approach, the use of the serum (1,3)-ß-D-glucan (BDG) test represents a valid tool for the early diagnosis and treatment of IFD. Areas covered: The available literature on the use of BDG in hematology patients was systematically retrieved. Then, it was reviewed and discussed, to identify key issues pertaining to a clinically-oriented narrative presentation of the topic. Expert commentary: The use of BDG in hematology patients at risk for invasive aspergillosis (IA) is secondary to the use of galactomannan. However, since BDG is not specific for IA, it offers an advantage of diagnosing also other IFD, such as candidiasis and pneumocystosis. The limitations of BDG include high costs and lower sensitivity in hematology patients compared to other cohorts. The risk of false positive results is possibly lower in real life than in theory, since glucan-free equipment is available and modern dialysis membranes and blood products usually do not release BDG. Thus, in experienced hands and selected clinical situations, BDG is a useful diagnostic tool, particularly due to short turnover time to results and versatility in diagnosing different IFD.
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Affiliation(s)
- Daniele Roberto Giacobbe
- a Infectious Diseases Unit, Ospedale Policlinico San Martino, IRCCS per l'Oncologia, University of Genoa, DISSAL , Genoa , Italy
| | - Valerio Del Bono
- a Infectious Diseases Unit, Ospedale Policlinico San Martino, IRCCS per l'Oncologia, University of Genoa, DISSAL , Genoa , Italy
| | - Claudio Viscoli
- a Infectious Diseases Unit, Ospedale Policlinico San Martino, IRCCS per l'Oncologia, University of Genoa, DISSAL , Genoa , Italy
| | - Malgorzata Mikulska
- a Infectious Diseases Unit, Ospedale Policlinico San Martino, IRCCS per l'Oncologia, University of Genoa, DISSAL , Genoa , Italy
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Winterholler M, Coras R, Geißdörfer W, Rammensee R, Gölitz P, Bogdan C, Lang R. Fatal Mycotic Aneurysm of the Basilar Artery Caused by Aspergillus fumigatus in a Patient with Pituitary Adenoma and Meningitis. Front Med (Lausanne) 2017; 4:113. [PMID: 28770205 PMCID: PMC5513951 DOI: 10.3389/fmed.2017.00113] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 07/04/2017] [Indexed: 12/03/2022] Open
Abstract
Fungal infections of the central nervous system (CNS) frequently occur in immunosuppressed patients. Here, we describe the case of an immunocompetent 64-year-old man who presented with diplopia, right-sided hemiparesis, and a mild headache after cleaning and replacing nesting boxes of wild birds during the preceding months. Lumbar puncture revealed pleocytosis, elevated protein, and lactate levels in the cerebrospinal fluid (CSF). Initial imaging showed ischemia in the left thalamus and an enlargement of the sellar region. Antibiotic treatment and corticosteroids led to an initial improvement but was followed by rapid deterioration. Antibiotic treatment was modified and antifungal therapy was added. Eighteen days after admission, the patient died from a subarachnoid hemorrhage resulting from the rupture of a fusiform aneurysm of the basilar artery. Microbiological culture of CSF was negative, but a positive galactomannan assay suggested fungal infection which was corroborated by detection of Aspergillus fumigatus DNA in pan-fungal PCR and sequencing. The presence of septated hyphae in the wall of the basilar artery confirmed the diagnosis of a mycotic aneurysm caused by hyphomycetal infection. In addition, brain autopsy revealed the presence of an invasive adrenocorticotrophic hormone-producing pituitary adenoma with arrosion of the sellar bone. This process and its invasiveness likely facilitated the spread of the fungal pathogen from the sphenoid sinus to the dura mater and finally led to cerebral angioinvasion. Our case demonstrates the challenge to timely diagnose and effectively treat aspergillosis as a cause of CNS infection also in apparently immunocompetent patients. The potential of assays detecting fungal antigens and of PCR to facilitate a timely diagnosis is discussed.
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Affiliation(s)
| | - Roland Coras
- Department of Neuropathology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Walter Geißdörfer
- Mikrobiologisches Institut-Klinische Mikrobiologie, Immunologie und Hygiene, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Rudolf Rammensee
- Department of Neurosurgery, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Philipp Gölitz
- Department of Neuroradiology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Christian Bogdan
- Mikrobiologisches Institut-Klinische Mikrobiologie, Immunologie und Hygiene, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Roland Lang
- Mikrobiologisches Institut-Klinische Mikrobiologie, Immunologie und Hygiene, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
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Abstract
This chapter provides an overview of infectious syndromes, pathogens, and diagnostic testing modalities for central nervous system infections in the immunocompromised host.
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McCarthy MW, Petraitiene R, Walsh TJ. Translational Development and Application of (1→3)-β-d-Glucan for Diagnosis and Therapeutic Monitoring of Invasive Mycoses. Int J Mol Sci 2017; 18:ijms18061124. [PMID: 28538702 PMCID: PMC5485948 DOI: 10.3390/ijms18061124] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 05/09/2017] [Accepted: 05/16/2017] [Indexed: 12/24/2022] Open
Abstract
Early diagnosis and prompt initiation of appropriate antimicrobial therapy are crucial steps in the management of patients with invasive fungal infections. However, the diagnosis of invasive mycoses remains a major challenge in clinical practice, because presenting symptoms may be subtle and non-invasive diagnostic assays often lack sensitivity and specificity. Diagnosis is often expressed on a scale of probability (proven, probable and possible) based on a constellation of imaging findings, microbiological tools and histopathology, as there is no stand-alone assay for diagnosis. Recent data suggest that the carbohydrate biomarker (1→3)-β-d-glucan may be useful in both the diagnosis and therapeutic monitoring of invasive fungal infections due to some yeasts, molds, and dimorphic fungi. In this paper, we review recent advances in the use of (1→3)-β-d-glucan to monitor clinical response to antifungal therapy and explore how this assay may be used in the future.
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Affiliation(s)
- Matthew W McCarthy
- Division of General Internal Medicine, Weill Cornell Medicine of Cornell University, New York, NY 10065, USA.
| | - Ruta Petraitiene
- Transplantation-Oncology Infectious Diseases Program, Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine of Cornell University, New York, NY 10065, USA.
| | - Thomas J Walsh
- Departments of Pediatrics, and Microbiology & Immunology, Weill Cornell Medicine, New York, NY 10065, USA.
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Tunkel AR, Hasbun R, Bhimraj A, Byers K, Kaplan SL, Scheld WM, van de Beek D, Bleck TP, Garton HJL, Zunt JR. 2017 Infectious Diseases Society of America's Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis. Clin Infect Dis 2017; 64:e34-e65. [PMID: 28203777 DOI: 10.1093/cid/ciw861] [Citation(s) in RCA: 487] [Impact Index Per Article: 69.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 12/16/2016] [Indexed: 12/13/2022] Open
Abstract
The Infectious Diseases Society of America (IDSA) Standards and Practice Guidelines Committee collaborated with partner organizations to convene a panel of 10 experts on healthcare-associated ventriculitis and meningitis. The panel represented pediatric and adult specialists in the field of infectious diseases and represented other organizations whose members care for patients with healthcare-associated ventriculitis and meningitis (American Academy of Neurology, American Association of Neurological Surgeons, and Neurocritical Care Society). The panel reviewed articles based on literature reviews, review articles and book chapters, evaluated the evidence and drafted recommendations. Questions were reviewed and approved by panel members. Subcategories were included for some questions based on specific populations of patients who may develop healthcare-associated ventriculitis and meningitis after the following procedures or situations: cerebrospinal fluid shunts, cerebrospinal fluid drains, implantation of intrathecal infusion pumps, implantation of deep brain stimulation hardware, and general neurosurgery and head trauma. Recommendations were followed by the strength of the recommendation and the quality of the evidence supporting the recommendation. Many recommendations, however, were based on expert opinion because rigorous clinical data are not available. These guidelines represent a practical and useful approach to assist practicing clinicians in the management of these challenging infections.
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Affiliation(s)
- Allan R Tunkel
- Department of Internal Medicine-Infectious Diseases, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Rodrigo Hasbun
- Department of Infectious Diseases, the University of Texas Health Science Center at Houston, Texas
| | - Adarsh Bhimraj
- Department of Infectious Diseases, Cleveland Clinic, Ohio
| | - Karin Byers
- Division of Infectious Diseases, University of Pittsburgh Medical Center, Pennsylvania
| | - Sheldon L Kaplan
- Department of Pediatrics-Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas
| | - W Michael Scheld
- Division of Infectious Diseases, University of Virginia, Charlottesville
| | - Diederik van de Beek
- Department of Neurology, Academic Medical Center, Amsterdam Neuroscience, University of Amsterdam, The Netherlands
| | - Thomas P Bleck
- Departments of Neurological Sciences, Neurosurgery, Anesthesiology, and Medicine, Rush Medical College, Chicago, Illinois
| | - Hugh J L Garton
- Department of Neurological Surgery, University of Michigan, Ann Arbor; and
| | - Joseph R Zunt
- Departments of Neurology, Global Health, Medicine-Infectious Diseases, and Epidemiology, University of Washington, Seattle
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McCarthy MW, Walsh TJ. Molecular diagnosis of invasive mycoses of the central nervous system. Expert Rev Mol Diagn 2016; 17:129-139. [PMID: 27936983 DOI: 10.1080/14737159.2017.1271716] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
INTRODUCTION In September 2012, the Centers for Disease Control and Prevention (CDC) began investigating an outbreak of fungal meningitis among patients who had received contaminated preservative-free methyl prednisolone acetate injections from the New England Compounding Center in Framingham, Massachusetts. Thousands of patients were potentially exposed to tainted corticosteroids, but establishing the diagnosis of fungal meningitis during the nationwide outbreak was difficult because little was known about the natural history of the disease. Areas covered: The challenges associated with this outbreak highlighted the need for rapid and reliable methodologies to assist in the diagnosis of invasive mycoses of the central nervous system (IMCNS), which may be devastating and difficult to treat. In this paper, we review the causative agents of these potentially-lethal infections, which include cryptococcal meningitis, cerebral aspergillosis, and hematogenous Candida meningoencephalitis. Expert commentary: While microscopy, culture, and histopathologic identification of fungal pathogens remain the gold standard for diagnosis, new platforms and species-specific assays have recently emerged, including lateral flow immunoassays (LFA), matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS), and multiplex PCR in conjunction with magnetic resonance (MR) to potentially aid in the diagnosis of IMCNS.
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Affiliation(s)
- Matthew William McCarthy
- a Hospital Medicine , Joan and Sanford I Weill Medical College of Cornell University , New York , NY , USA
| | - Thomas J Walsh
- b Transplantation-Oncology Infectious Diseases Program , Weill Cornell Medical Center , New York , NY , USA
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Chen TK, Groncy PK, Javahery R, Chai RY, Nagpala P, Finkelman M, Petraitiene R, Walsh TJ. Successful treatment of Aspergillus ventriculitis through voriconazole adaptive pharmacotherapy, immunomodulation, and therapeutic monitoring of cerebrospinal fluid (1→3)-β-D-glucan. Med Mycol 2016; 55:109-117. [PMID: 27838641 DOI: 10.1093/mmy/myw118] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 06/08/2016] [Accepted: 10/30/2016] [Indexed: 11/13/2022] Open
Abstract
Aspergillus ventriculitis is an uncommon but often fatal form of invasive aspergillosis of the central nervous system (CNS). As little is known about the diagnosis, treatment, and outcome of this potentially lethal infection, we report the strategies used to successfully treat Aspergillus ventriculitis complicating a pineal and pituitary germinoma with emphasis on the critical role of adaptive pharmacotherapy of voriconazole and serial monitoring of (1→3)-β-D-glucan in cerebrospinal fluid. We describe several rationally based therapeutic modalities, including adaptive pharmacotherapy, combination therapy, sargramostim-based immunomodulation, and biomarker-based therapeutic monitoring of the CNS compartment. Through these strategies, our patient remains in remission from both his germinoma and Aspergillus ventriculitis making him one of the few survivors of Aspergillus ventriculitis.
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Affiliation(s)
- Tempe K Chen
- Pediatric Infectious Diseases, Department of Pediatrics, Miller Children's and Women's Hospital, Long Beach, CA, USA.,University of California, Irvine, Irvine, CA, USA
| | - Paula K Groncy
- Hematology-Oncology, Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Ramin Javahery
- Neurosurgery, Long Beach Memorial Medical Center, Miller Children's and Women's Hospital, Long Beach, CA, USA
| | - Richard Y Chai
- Radiology, Long Beach Memorial Medical Center, Miller Children's and Women's Hospital, Long Beach, CA, USA
| | - Pablito Nagpala
- Endocrinology, Department of Pediatrics, Miller Children's and Women's Hospital, Long Beach, CA, USA
| | | | - Ruta Petraitiene
- Transplantation-Oncology Infectious Diseases Program and Infectious Diseases Translational Research Laboratory, Division of Infectious Diseases, Weill Cornell Medicine, New York, NY, USA
| | - Thomas J Walsh
- Transplantation-Oncology Infectious Diseases Program and Infectious Diseases Translational Research Laboratory, Division of Infectious Diseases, Weill Cornell Medicine, New York, NY, USA .,Departments of Pediatrics, and Microbiology & Immunology, Weill Cornell Medicine, New York, NY, USA
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Farrugia MK, Fogha EP, Miah AR, Yednock J, Palmer HC, Guilfoose J. Candida meningitis in an immunocompetent patient detected through (1→3)-beta-d-glucan. Int J Infect Dis 2016; 51:25-26. [DOI: 10.1016/j.ijid.2016.08.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 08/23/2016] [Accepted: 08/24/2016] [Indexed: 10/21/2022] Open
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Abstract
Central nervous system (CNS) infections are potentially life threatening if not diagnosed and treated early. The initial clinical presentations of many CNS infections are non-specific, making a definitive etiologic diagnosis challenging. Nucleic acid in vitro amplification-based molecular methods are increasingly being applied for routine microbial detection. These methods are a vast improvement over conventional techniques with the advantage of rapid turnaround and higher sensitivity and specificity. Additionally, molecular methods performed on cerebrospinal fluid samples are considered the new gold standard for diagnosis of CNS infection caused by pathogens, which are otherwise difficult to detect. Commercial diagnostic platforms offer various monoplex and multiplex PCR assays for convenient testing of targets that cause similar clinical illness. Pan-omic molecular platforms possess potential for use in this area. Although molecular methods are predicted to be widely used in diagnosing and monitoring CNS infections, results generated by these methods need to be carefully interpreted in combination with clinical findings. This review summarizes the currently available armamentarium of molecular assays for diagnosis of central nervous system infections, their application, and future approaches.
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Cerebrospinal Fluid (1,3)-Beta-d-Glucan Testing Is Useful in Diagnosis of Coccidioidal Meningitis. J Clin Microbiol 2016; 54:2707-2710. [PMID: 27558179 DOI: 10.1128/jcm.01224-16] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 08/16/2016] [Indexed: 11/20/2022] Open
Abstract
Diagnosing coccidioidal meningitis (CM) can be problematic owing to its infrequency and/or a delay in the positivity of a cerebrospinal fluid (CSF) culture or CSF antibody, particularly if the primary coccidioidal infection is unrecognized. We tested 37 CSF specimens, 26 from patients with confirmed CM and 11 from patients with suspected microbial meningitis without fungal diagnosis, for (1,3)-beta-glucan (BG). BG in CM CSF specimens ranged from 18 to 3,300 pg/ml and in controls ranged from <3.9 to 103 pg/ml. Diagnostic performance was determined using a 31-pg/ml cutoff (the bottom of the serum range according to the directions for the commercial kit, although further serial dilutions of the standard indicated linearity to 3.9). Sensitivity was 96%, specificity was 82%, positive and negative predictive values were 93% and 90%, and the area under the receiver operating characteristic curve was 0.937. Fifteen of 15 samples of >103 pg/ml were CM. The one false-negative specimen was from a patient with a pseudosyrinx, without inflammatory evidence of meningitis activity. Serial samples from some patients were positive at ≤8 years, indicating no loss of positivity with chronicity. Samples stored frozen since 2000 included those with 2 of the 3 highest values, indicating that fresh samples not required. A previous study indicated serum sensitivities of 53% in acute, 50% in resolved, and 83% in disseminated and meningeal coccidioidomycosis. Three studies of other fungal meningitides ranged from 86 to 1,524 pg/ml CSF, with 37 controls of <4 to 115 pg/ml CSF. CSF BG analysis had good diagnostic performance in CM. CSF BG testing can be useful in CM, and a commercial kit is available. It will be of interest to correlate this with course, treatment, outcome, inflammation, and antigen. The only mycoses with common central nervous system (CNS) involvement are cryptococcal and coccidioidal, so CSF BG screening can be useful in meningitis diagnosis.
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Ceccarelli G, Ghezzi MC, Raponi G, Brunetti G, Marsiglia C, Fallani S, Novelli A, Venditti M. Voriconazole treatment of Candida tropicalis meningitis: persistence of (1,3)-β-D-glucan in the cerebrospinal fluid is a marker of clinical and microbiological failure: A case report. Medicine (Baltimore) 2016; 95:e4474. [PMID: 27495087 PMCID: PMC4979841 DOI: 10.1097/md.0000000000004474] [Citation(s) in RCA: 7] [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: 01/05/2023] Open
Abstract
INTRODUCTION Infections are still the most common complications of cerebral shunt procedures. Even though fungal etiologies are considered to be rare, they are associated with significant morbidity and mortality. Due to their uncommonness, diagnostic procedures and optimal therapy are poorly defined. We report a case of Candida tropicalis infection of ventriculo-peritoneal cerebrospinal fluid (CSF) shunt in a 49-year-old immune competent male treated with voriconazole (VOR). METHODS Microbiological and CSF markers (1,3-b-D-glucan-BDG) of fungal infection, biofilm production capacity, sensitivity of serial isolates of the pathogen, and the concentration of the antifungal drug have been monitored and related to the clinical course of this infection. RESULTS Despite appropriate treatment with VOR, in terms of adequate achieved CSF drug concentrations and initial effective therapeutic response, loss of VOR susceptibility of the C tropicalis and treatment failure were observed. CONCLUSION Biofilm production of the C. tropicalis isolate might have had a significant role in treatment failure. Of interest, clinical and microbiological unfavorable outcome was anticipated by persistence of BDG in CSF. Rising titers of this marker were associated with relapse of fungal infection.
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Affiliation(s)
- Giancarlo Ceccarelli
- Department of Public Health and Infectious Diseases. University of Rome “Sapienza”, Azienda Policlinico Umberto I, Rome
| | - Maria Cristina Ghezzi
- Department of Public Health and Infectious Diseases. University of Rome “Sapienza”, Azienda Policlinico Umberto I, Rome
| | - Giammarco Raponi
- Department of Public Health and Infectious Diseases. University of Rome “Sapienza”, Azienda Policlinico Umberto I, Rome
| | - Grazia Brunetti
- Department of Public Health and Infectious Diseases. University of Rome “Sapienza”, Azienda Policlinico Umberto I, Rome
| | - Carolina Marsiglia
- Department of Public Health and Infectious Diseases. University of Rome “Sapienza”, Azienda Policlinico Umberto I, Rome
| | - Stefania Fallani
- Department of Health Sciences (DSS), Section of Clinical Pharmacology and Oncology, Università degli Studi, Florence, Italy
| | - Andrea Novelli
- Department of Health Sciences (DSS), Section of Clinical Pharmacology and Oncology, Università degli Studi, Florence, Italy
| | - Mario Venditti
- Department of Public Health and Infectious Diseases. University of Rome “Sapienza”, Azienda Policlinico Umberto I, Rome
- Correspondence: Mario Venditti, Department of Public Health and Infectious Diseases, University of Rome “Sapienza”, Azienda Policlinico Umberto I, Viale del Policlinico 155, 00161 Rome, Italy (e-mail: )
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Lyons JL, Zhang SX. Current laboratory approaches to diagnosis of CNS fungal infections. Future Microbiol 2016; 11:175-7. [PMID: 26849164 DOI: 10.2217/fmb.15.138] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Jennifer L Lyons
- Brigham & Women's Hospital & Harvard Medical School, Boston, MA, USA
| | - Sean X Zhang
- Microbiology Laboratory, Johns Hopkins Hospital, Baltimore, MD, USA.,Division of Medical Microbiology, Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
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Hankovszky P, Társy D, Öveges N, Molnár Z. Invasive Candida Infections in the ICU: Diagnosis and Therapy. ACTA ACUST UNITED AC 2015; 1:129-139. [PMID: 29967821 DOI: 10.1515/jccm-2015-0025] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 09/15/2015] [Indexed: 11/15/2022]
Abstract
Invasive fungal infections have become a serious problem in the critically ill. One of the main reasons is the development of an immunocompromised condition. The most frequently found pathogens are Candida species. In order to provide adequate treatment, understanding this potentially life-threatening infection is mandatory. The aim of this summary is to view Candida infections from a different perspective and to give an overview on epidemiology, the range of pathophysiology from colonization to the invasive infections, and its impact on mortality. New therapeutic options will also be discussed and how these relate to current guidelines. Finally, the key issue of the choice of anti-fungal agents will be evaluated.
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Affiliation(s)
- Péter Hankovszky
- Department of Anaesthesiology and Intensive Therapy, University of Szeged, Albert Szent-Györgyi Health Center, Szeged, Hungary
| | - Domokos Társy
- Department of Anaesthesiology and Intensive Therapy, University of Szeged, Albert Szent-Györgyi Health Center, Szeged, Hungary
| | - Nándor Öveges
- Department of Anaesthesiology and Intensive Therapy, University of Szeged, Albert Szent-Györgyi Health Center, Szeged, Hungary
| | - Zsolt Molnár
- Department of Anaesthesiology and Intensive Therapy, University of Szeged, Albert Szent-Györgyi Health Center, Szeged, Hungary
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Haidar G, Falcione BA, Nguyen MH. Diagnostic Modalities for Invasive Mould Infections among Hematopoietic Stem Cell Transplant and Solid Organ Recipients: Performance Characteristics and Practical Roles in the Clinic. J Fungi (Basel) 2015; 1:252-276. [PMID: 29376911 PMCID: PMC5753113 DOI: 10.3390/jof1020252] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2015] [Revised: 08/28/2015] [Accepted: 08/31/2015] [Indexed: 12/19/2022] Open
Abstract
The morbidity and mortality of hematopoietic stem cell and solid organ transplant patients with invasive fungal infections (IFIs) remain high despite an increase in the number of effective antifungal agents. Early diagnosis leading to timely administration of antifungal therapy has been linked to better outcomes. Unfortunately, the diagnosis of IFIs remains challenging. The current gold standard for diagnosis is a combination of histopathology and culture, for which the sensitivity is <50%. Over the past two decades, a plethora of non-culture-based antigen and molecular assays have been developed and clinically validated. In this article, we will review the performance of the current commercially available non-cultural diagnostics and discuss their practical roles in the clinic.
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Affiliation(s)
- Ghady Haidar
- Department of Medicine, University of Pittsburgh Medical Center, Scaife Hall, Suite 871, 3550 Terrace Street, Pittsburgh, PA 15261, USA.
| | - Bonnie A Falcione
- Department of Medicine, University of Pittsburgh Medical Center, Scaife Hall, Suite 871, 3550 Terrace Street, Pittsburgh, PA 15261, USA.
- Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, 200 Lothrop St. 301, Pittsburgh, PA 15213, USA.
- Department of Medicine, University of Pittsburgh, Scaife Hall, Suite 871, 3550 Terrace Street, Pittsburgh, PA 15261, USA.
| | - M Hong Nguyen
- Department of Medicine, University of Pittsburgh Medical Center, Scaife Hall, Suite 871, 3550 Terrace Street, Pittsburgh, PA 15261, USA.
- Department of Medicine, University of Pittsburgh, Scaife Hall, Suite 871, 3550 Terrace Street, Pittsburgh, PA 15261, USA.
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