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Hua Y, Hu F, Ren X, Xiong Y, Hu J, Su F, Tang X, Wen Y. A novel aptamer-G-quadruplex/hemin self-assembling color system: rapid visual diagnosis of invasive fungal infections. Ann Clin Microbiol Antimicrob 2023; 22:35. [PMID: 37170137 PMCID: PMC10176924 DOI: 10.1186/s12941-023-00570-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 02/24/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND The clinical symptoms of invasive fungal infections (IFI) are nonspecific, and early clinical diagnosis is challenging, resulting in high mortality rates. This study reports the development of a novel aptamer-G-quadruplex/hemin self-assembling color system (AGSCS) based on (1 → 3)-β-D-glucans' detection for rapid, specific and visual diagnosis of IFI. METHODS We screened high affinity and specificity ssDNA aptamers binding to (1 → 3)-β-D-glucans, the main components of cell wall from Candida albicans via Systematic Evolution of Ligands by EXponential enrichment. Next, a comparison of diagnostic efficiency of AGSCS and the (1 → 3)-β-D-glucans assay ("G test") with regard to predicting IFI in 198 clinical serum samples was done. RESULTS Water-soluble (1 → 3)-β-D-glucans were successfully isolated from C. albicans ATCC 10,231 strain, and these low degree of polymerization glucans (< 1.7 kD) were targeted for aptamer screening with the complementary sequences of G-quadruplex. Six high affinity single stranded DNA aptamers (A1, A2, A3, A4, A5 and A6) were found. The linear detection range for (1 → 3)-β-D-glucans stretched from 1.6 pg/mL to 400 pg/mL on a microplate reader, and the detection limit was 3.125 pg/mL using naked eye observation. Using a microplate reader, the sensitivity and specificity of AGSCS for the diagnosis of IFI were 92.68% and 89.65%, respectively, which was higher than that of the G test. CONCLUSION This newly developed visual diagnostic method for detecting IFI showed promising results and is expected to be developed as a point-of-care testing kit to enable quick and cost effective diagnosis of IFI in the future.
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Affiliation(s)
- Ying Hua
- School of Nursing, Wannan Medical College, Wuhu, 241000, Anhui, China
| | - Feng Hu
- Department of Blood Transfusion, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital of Wannan Medical College), Wuhu, 241000, Anhui, China
| | - Xia Ren
- School of Public Health, Wannan Medical College, No.22, Wenchang Xi Road, Wuhu, 241002, Anhui, China
| | - Yueling Xiong
- Centre of Translational Medicine and Vascular Disease Research Center, The Second Affiliated Hospital of Wannan Medical College, Kangfu Road 10#, Jinghu District, Wuhu, 241000, Anhui, China
| | - Jian Hu
- School of Public Health, Wannan Medical College, No.22, Wenchang Xi Road, Wuhu, 241002, Anhui, China
| | - Fan Su
- School of Public Health, Wannan Medical College, No.22, Wenchang Xi Road, Wuhu, 241002, Anhui, China
| | - Xiaolei Tang
- Centre of Translational Medicine and Vascular Disease Research Center, The Second Affiliated Hospital of Wannan Medical College, Kangfu Road 10#, Jinghu District, Wuhu, 241000, Anhui, China.
| | - Yufeng Wen
- School of Public Health, Wannan Medical College, No.22, Wenchang Xi Road, Wuhu, 241002, Anhui, China.
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Susianti H, Parmadi L, Firani NK, Setyawan UA, Sartono TR. Diagnostic value of serum human Galactomannan aspergillus antigen and 1,3-beta-D-glucan in immunocompromised patient suspected fungal infection. J Clin Lab Anal 2021; 35:e23806. [PMID: 33945177 PMCID: PMC8183930 DOI: 10.1002/jcla.23806] [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: 03/04/2021] [Revised: 04/08/2021] [Accepted: 04/10/2021] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND The prevalence of fungal infection (FI) in developing countries is high, but the diagnosis of FI is still challenging to determine, so it is needed evaluation of biomarkers other than microbiological culture, because the culture has low sensitivity, high cost, not available in every laboratory and needs a long time. The detection of human galactomannan Aspergillus antigen (GAL) and 1,3-beta-D-glucan (BDG) on the fungal cell wall could be the promising biomarkers for fungal infection. Neutropenia, lymphopenia and CD4T cells in the immunocompromised patients are essential factors, but these cell associations with BDG and GAL levels have not been evaluated yet. The study aimed to evaluate GAL and BDG for detecting fungal infection and their association with total leucocyte count, neutrophil, monocyte, lymphocyte and CD4T cells. METHOD A cross-sectional study was conducted among 86 patient with suspected FI. Fungal infection established using EORTC/MSG criteria. Serology test performed using ELISA. Leucocyte cells were measured using a haematology autoanalyser, and CD4T cells were analysed using BD FACSPresto. Statistical analysis obtained using Spearman's correlation coefficient, ROC curve analysis and 2 × 2 contingency table. RESULTS Serum Galactomannan and BDG had a significant correlation with CD4T cells and total lymphocyte count (p < 0.05). The cut-off OD GAL >0.3 had sensitivity 54.6%, specificity 87.5% and AUC 0.71; meanwhile, the BDG cut-off >115.78 pg/ mL had sensitivity 71.2%, specificity 52.4% and AUC 0.63 for detecting fungal infection. CONCLUSIONS The immunocompromised patients can undergo GAL for determining the diagnose of FI. The lower the CD4T cells and total lymphocyte count, the higher the GAL and BDG serum levels.
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Affiliation(s)
- Hani Susianti
- Clinical Pathology Department of Faculty Medicine Brawijaya University, Dr. Saiful Anwar General Hospital, Malang, Indonesia
| | - Lydiana Parmadi
- Clinical Pathology Department of Faculty Medicine Brawijaya University, Dr. Saiful Anwar General Hospital, Malang, Indonesia
| | - Novi Khila Firani
- Clinical Pathology Department of Faculty Medicine Brawijaya University, Dr. Saiful Anwar General Hospital, Malang, Indonesia
| | - Ungky Agus Setyawan
- Pulmonology and Respiratory Department of Faculty Medicine Brawijaya University, Dr. Saiful Anwar General Hospital, Malang, Indonesia
| | - Teguh Rahayu Sartono
- Pulmonology and Respiratory Department of Faculty Medicine Brawijaya University, Dr. Saiful Anwar General Hospital, Malang, Indonesia
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Jillwin J, Rudramurthy SM, Singh S, Bal A, Das A, Radotra B, Prakash H, Dhaliwal M, Kaur H, Ghosh AK, Chakrabarti A. Molecular identification of pathogenic fungi in formalin-fixed and paraffin-embedded tissues. J Med Microbiol 2021; 70. [PMID: 33252325 DOI: 10.1099/jmm.0.001282] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Introduction. Histopathological examination (HPE) of tissue helps in the diagnosis of invasive fungal infections (IFIs) but cannot identify the fungus to the genus/species levelGap Statement Available protocols for the molecular identification of fungi from formalin-fixed and paraffin-embedded (FFPE) tissues have limitations in terms of extraction and target selection, and standardisation.Aim. Development of sequence-based fungal identification protocol after extraction of DNA from formalin-fixed and paraffin-embedded (FFPE) tissues.Methodology. A total of 63 FFPE tissues from histopathology proven IFI cases were used to standardize the DNA extraction (commercial QIAamp kit-based extraction and conventional phenol-chloroform-isoamyl alcohol [PCI] method) and sequence-based fungal identification protocols. The PCR targeted different ribosomal DNA (rDNA) regions including complete internal transcribed spacer (ITS1-5.8S-ITS2), separate ITS1 and ITS2, 18S and D1/D2 of 28S regions. Semi-nested PCR targeting Mucorales-specific 18S rDNA region was performed in tissues having aseptate hyphae. The optimized ITS1-PCR protocol was evaluated in 119 FFPE tissues containing septate hyphae or yeast, and Mucorales-specific semi-nested PCR in 126 FFPE tissues containing aseptate hyphae.Results. The DNA yield by conventional PCI method was significantly higher (P<0.0001) than commercial kit, though the quality of DNA was similar by both protocols. The test accuracy was best while using ITS1 (61.9 %) as the target compared to 7.9, 29.9 and 22.2 % on targeting ITS1-5.8S-ITS2, ITS2, the D1/D2 region of 28S, respectively. The test accuracies of ITS1-PCR in tissues containing septate hyphae, aseptate hyphae and yeasts were 75.5, 18.7 and 100 %, respectively. The amplification (targeting ITS1 region) improved by increasing the thickness of tissue section (up to 50 µm) used for DNA extraction. ITS1-PCR protocol could amplify fungal DNA in 76 (63.8 %) tissues and Mucorales-specific semi-nested PCR in 86 (68.3 %) tissues.Conclusion. Conventional PCI-based DNA extraction from thick tissue (50 µm) may be used until optimal commercial fungal DNA extraction kit is developed. Subsequent ITS1-PCR for septate fungi and yeast, and semi-nested PCR targeting 18S rDNA for Mucorales are recommended to identify the fungus in FFPE tissues.
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Affiliation(s)
- Joseph Jillwin
- Present address: Lecturer of Microbiology, Xavier University School of Medicine, Oranjestad, Aruba.,Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shivaprakash M Rudramurthy
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shreya Singh
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Amanjit Bal
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashim Das
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Bishan Radotra
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Hariprasath Prakash
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Manpreet Dhaliwal
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Harsimran Kaur
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anup K Ghosh
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arunaloke Chakrabarti
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Special Staining of the Liquid-Based Cytopathology Test in Bronchoalveolar Lavage Fluid for Diagnosis of Invasive Pulmonary Aspergillosis with Nonneutropenic Patients. Can Respir J 2020; 2020:8243473. [PMID: 32318126 PMCID: PMC7150679 DOI: 10.1155/2020/8243473] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 02/14/2020] [Indexed: 12/19/2022] Open
Abstract
In recent years, various biomarkers have been gradually applied on bronchoalveolar lavage (BAL) fluid for the diagnosis of invasive pulmonary aspergillosis (IPA). The objective of this study is to assess the value of the liquid-based cytopathology test (LCT) for improving the identification of IPA in BAL fluid from possible IPA patients, following special staining with periodic acid-Schiff staining (PAS) or Grocott's methenamine silver (GMS). A total of 47 consecutive possible IPA patients who underwent bronchoscopy with BAL fluid from January 2017 to December 2018 were included. 45 people had a pair of BAL fluid specimens and 2 patients had two BAL fluid specimens. The 49 pairs of BAL fluid specimens were processed for culture, tuberculosis acid fast staining smear, direct microbial smear, and LCT with special staining (PAS and GMS), respectively. Then, we compared the sensitivity and specificity of PAS and GMS in BAL fluid in high-risk patients. Among 47 possible IPA patients, 25 patients had proven/probable IPA, and 11 patients had other invasive fungal diseases. The sensitivity of GMS was higher than that of PAS (92.11% versus 81.58%; P = 0.175). The specificity of GMS was 81.82%, which was higher than that of PAS (81.82% versus 72.73%; P = 0.611). The negative predictive value (NPV) for PAS and GMS were 53.33% and 75.00%, respectively. The positive predictive value (PPV) for PAS and GMS were 91.18% and 94.59%, respectively. This study showed that special staining of LCT in BAL fluid may be a novel method for the diagnosis of IPA, and the GMS of LCT had higher sensitivity and specificity, which was superior to PAS.
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Carlesse F, Daudt LE, Seber A, Dutra ÁP, Melo ASDA, Simões B, Macedo CRD, Bonfim C, Benites E, Gregianin L, Batista MV, Abramczyk M, Tostes V, Lederman HM, Lee MLDM, Loggetto S, Galvão de Castro Junior C, Colombo AL. A consensus document for the clinical management of invasive fungal diseases in pediatric patients with hematologic cancer and/or undergoing hematopoietic stem cell transplantation in Brazilian medical centers. Braz J Infect Dis 2019; 23:395-409. [PMID: 31738887 PMCID: PMC9428207 DOI: 10.1016/j.bjid.2019.09.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 09/10/2019] [Accepted: 09/28/2019] [Indexed: 01/05/2023] Open
Abstract
In the present paper we summarize the suggestions of a multidisciplinary group including experts in pediatric oncology and infectious diseases who reviewed the medical literature to elaborate a consensus document (CD) for the diagnosis and clinical management of invasive fungal diseases (IFDs) in children with hematologic cancer and those who underwent hematopoietic stem-cell transplantation. All major multicenter studies designed to characterize the epidemiology of IFDs in children with cancer, as well as all randomized clinical trials addressing empirical and targeted antifungal therapy were reviewed. In the absence of randomized clinical trials, the best evidence available to support the recommendations were selected. Algorithms for early diagnosis and best clinical management of IFDs are also presented. This document summarizes practical recommendations that will certainly help pediatricians to best treat their patients suffering of invasive fungal diseases.
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Affiliation(s)
- Fabianne Carlesse
- Instituto de Oncologia Pediátrica, UNIFESP, São Paulo, SP, Brazil; Universidade Federal de São Paulo, Escola Paulista de Medicina (EPM), UNIFESP, São Paulo, SP, Brazil.
| | - Liane Esteves Daudt
- Universidade do Rio Grande do Sul, Hospital das Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.
| | - Adriana Seber
- Hospital Samaritano de São Paulo, São Paulo, SP, Brazil; ABHH, Brazil.
| | | | | | - Belinda Simões
- Hospital das Clínicas de Ribeirão Preto-USP, São Paulo, SP, Brazil.
| | | | - Carmem Bonfim
- Hospital das Clínicas de Curitiba, Paraná, PR, Brazil.
| | | | - Lauro Gregianin
- Hospital das Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.
| | - Marjorie Vieira Batista
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo, SP, Brazil.
| | - Marcelo Abramczyk
- Hospital Infantil Darcy Vargas, Morumbi, SP, Brazil; Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Pediatria, São Paulo, SP, Brazil.
| | - Vivian Tostes
- Pro-Imagem medicina diagnóstica Ribeirão Preto, SP, Brazil.
| | | | - Maria Lúcia de Martino Lee
- Hospital Santa Marcelina TUCA, São Paulo, SP, Brazil; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | | | | | - Arnaldo Lopes Colombo
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Disciplina de Infectologia, Brazil.
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del Rocío Reyes-Montes M, Duarte-Escalante E, Guadalupe Frías-De-León M, Obed Martínez-Herrera E, Acosta-Altamirano G. Molecular Diagnosis of Invasive Aspergillosis. Mol Med 2019. [DOI: 10.5772/intechopen.78694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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7
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Patterson TF, Donnelly JP. New Concepts in Diagnostics for Invasive Mycoses: Non-Culture-Based Methodologies. J Fungi (Basel) 2019; 5:E9. [PMID: 30658509 PMCID: PMC6463019 DOI: 10.3390/jof5010009] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 01/14/2019] [Accepted: 01/15/2019] [Indexed: 12/22/2022] Open
Abstract
Non-culture-based diagnostics have been developed to help establish an early diagnosis of invasive fungal infection. Studies have shown that these tests can significantly impact the diagnosis of infection in high risk patients. Aspergillus galactomannan EIA testing is well-recognized as an important adjunct to the diagnosis of invasive aspergillosis and can be detected in serum, bronchoalveolar lavage and other fluids. Galactomannan testing used along with PCR testing has been shown to be effective when integrated into care paths for high risk patients for both diagnoses and as a surrogate marker for outcome when used in serial testing. Beta-d-glucan assays are non-specific for several fungal genera including Aspergillus and Candida and in high risk patients have been an important tool to augment the diagnosis. Lateral flow technology using monoclonal antibodies to Aspergillus are available that allow rapid testing of clinical samples. While standard PCR for Candida remains investigational, T2 magnetic resonance allows for the rapid diagnosis of Candida species from blood cultures. Aspergillus PCR has been extensively validated with standardized approaches established for these methods and will be included in the diagnostic criteria in the revised European Organization for Research and Treatment of Cancer/Mycoses Study Group (EORTC-MSG) definitions. Finally, these non-culture-based tests can be used in combination to significantly increase the detection of invasive mycoses with the ultimate aim of establishing an early diagnosis of infection.
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Affiliation(s)
- Thomas F Patterson
- Division of Infectious Diseases, San Antonio Center for Medical Mycology, The University of Texas Health Science Center at San Antonio and the South Texas Veterans Health Care System, 7703 Floyd Curl Drive-MSC 7881, San Antonio, TX 78229-3900, USA.
| | - J Peter Donnelly
- Division of Infectious Diseases, San Antonio Center for Medical Mycology, The University of Texas Health Science Center at San Antonio and the South Texas Veterans Health Care System, 7703 Floyd Curl Drive-MSC 7881, San Antonio, TX 78229-3900, USA.
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Zhang L, Guo Z, Xie S, Zhou J, Chen G, Feng J, Huang Y. The performance of galactomannan in combination with 1,3-β-D-glucan or aspergillus-lateral flow device for the diagnosis of invasive aspergillosis: Evidences from 13 studies. Diagn Microbiol Infect Dis 2018; 93:44-53. [PMID: 30279025 DOI: 10.1016/j.diagmicrobio.2018.08.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 08/03/2018] [Accepted: 08/14/2018] [Indexed: 12/11/2022]
Abstract
Galactomannan (GM), 1,3-β-D-glucan (BDG) and aspergillus-lateral flow device (LFD) are recognized as diagnostic tools for invasive aspergillosis (IA). The combined performance of these assays, however, is inconsistent in various studies. We undertook a meta-analysis of 13 studies involving 1513 patients to evaluate the utility of GM in combination with BDG or LFD for diagnosing IA. The pooled SEN, SPE, PLR, NLR and diagnostic odds ratio (DOR) were calculated and constructed to summarize the overall combined performance. Combining both positive results of GM and BDG assays leaded to the pooled SEN 0.49 (95%CI 0.27-0.72), SPE 0.98 (95%CI 0.94-1.00), PLR 31.68 (95%CI 5.36-187.37), NLR 0.52 (95%CI 0.32-0.84) and DOR 61.23 (95%CI 6.96-538.90). Comparing with GM and BDG assays, both positive results of GM and LFD leaded to high SEN, similar SPE, low PLR and NLR. At least one positive result of GM or LFD conferred great SEN 0.93 and low NLR 0.08. Both positive results of GM and BDG or LFD assay were in favor of confirming the existence of IA. And both negative results of GM and LFD were beneficial to rule out IA. Further studies with sufficient sample size should focus on the diagnostic performance and cost-effectiveness of these combined tests in clinical setting.
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Affiliation(s)
- Li Zhang
- Clinical microbiology laboratory, Tung Wah Hospital Affiliated to Sun Yat-sen University, Dongguan, Guangdong 523110, China.
| | - Zhusheng Guo
- Clinical microbiology laboratory, Tung Wah Hospital Affiliated to Sun Yat-sen University, Dongguan, Guangdong 523110, China
| | - Shujin Xie
- Clinical microbiology laboratory, Tung Wah Hospital Affiliated to Sun Yat-sen University, Dongguan, Guangdong 523110, China
| | - Jing Zhou
- Clinical microbiology laboratory, Tung Wah Hospital Affiliated to Sun Yat-sen University, Dongguan, Guangdong 523110, China
| | - Guiling Chen
- Clinical microbiology laboratory, Tung Wah Hospital Affiliated to Sun Yat-sen University, Dongguan, Guangdong 523110, China
| | - Jianbo Feng
- Clinical microbiology laboratory, Tung Wah Hospital Affiliated to Sun Yat-sen University, Dongguan, Guangdong 523110, China
| | - Ya Huang
- Clinical microbiology laboratory, Tung Wah Hospital Affiliated to Sun Yat-sen University, Dongguan, Guangdong 523110, China
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Furfaro E, Giacobbe DR, Del Bono V, Signori A, Guolo F, Minetto P, Clavio M, Ballerini F, Gobbi M, Viscoli C, Mikulska M. Performance of serum (1,3)-ß-d-glucan screening for the diagnosis of invasive aspergillosis in neutropenic patients with haematological malignancies. Mycoses 2018; 61:650-655. [PMID: 29693758 DOI: 10.1111/myc.12787] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 04/13/2018] [Accepted: 04/14/2018] [Indexed: 01/22/2023]
Abstract
We report our experience with the use of (1,3)-ß-d-glucan (BDG) screening for the diagnosis of invasive aspergillosis (IA) in neutropenic patients with haematological malignancies. The performance of BDG screening was assessed retrospectively in per patient and per sample analyses. Overall, 20 among 167 patients developed IA (12%). In the per patient analysis, BDG showed 60% sensitivity and 78% specificity when the criterion for positivity was the presence of at least one BDG value ≥80 pg/mL. For 2 consecutive positive results, sensitivity decreased to 40%, while specificity increased to 93% and was similar to that of a positive galactomannan (GM; 90%). The highest specificity (97%) was observed for combined positivity of at least one BDG and at least one GM. In the per sample analysis, the specificity of BDG was 100% in the best scenario, 96% in the median scenario and 89% in the worst scenario. BDG became positive before GM in 33% of IA patients with both markers positive (n = 12). Despite good specificity for 2 consecutive positive results, the BDG test offered unsatisfactory performance for the diagnosis of IA due to low sensitivity. The combination of BDG and GM showed the potential for increasing specificity.
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Affiliation(s)
- Elisa Furfaro
- Department Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Daniele Roberto Giacobbe
- Infectious Diseases Unit, Department Health Sciences (DISSAL), Ospedale Policlinico San Martino - IRCCS per l'Oncologia, University of Genoa, Genoa, Italy
| | - Valerio Del Bono
- Infectious Diseases Unit, Department Health Sciences (DISSAL), Ospedale Policlinico San Martino - IRCCS per l'Oncologia, University of Genoa, Genoa, Italy
| | - Alessio Signori
- Department Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Fabio Guolo
- Clinic of Haematology, Department of Internal Medicine (DiMI), Ospedale Policlinico San Martino - IRCCS per l'Oncologia, University of Genoa, Genoa, Italy
| | - Paola Minetto
- Clinic of Haematology, Department of Internal Medicine (DiMI), Ospedale Policlinico San Martino - IRCCS per l'Oncologia, University of Genoa, Genoa, Italy
| | - Marino Clavio
- Clinic of Haematology, Department of Internal Medicine (DiMI), Ospedale Policlinico San Martino - IRCCS per l'Oncologia, University of Genoa, Genoa, Italy
| | - Filippo Ballerini
- Clinic of Haematology, Department of Internal Medicine (DiMI), Ospedale Policlinico San Martino - IRCCS per l'Oncologia, University of Genoa, Genoa, Italy
| | - Marco Gobbi
- Clinic of Haematology, Department of Internal Medicine (DiMI), Ospedale Policlinico San Martino - IRCCS per l'Oncologia, University of Genoa, Genoa, Italy
| | - Claudio Viscoli
- Infectious Diseases Unit, Department Health Sciences (DISSAL), Ospedale Policlinico San Martino - IRCCS per l'Oncologia, University of Genoa, Genoa, Italy
| | - Malgorzata Mikulska
- Infectious Diseases Unit, Department Health Sciences (DISSAL), Ospedale Policlinico San Martino - IRCCS per l'Oncologia, University of Genoa, Genoa, Italy
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Corneal biopsy for diagnosis of recalcitrant microbial keratitis. Graefes Arch Clin Exp Ophthalmol 2018; 256:1527-1533. [DOI: 10.1007/s00417-018-3981-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 02/20/2018] [Accepted: 04/06/2018] [Indexed: 10/17/2022] Open
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Bao F, Fan Y, Sun L, Yu Y, Wang Z, Pan Q, Yu C, Liu H, Zhang F. Comparison of fungal fluorescent staining and ITS rDNA PCR-based sequencing with conventional methods for the diagnosis of onychomycosis. J Eur Acad Dermatol Venereol 2018; 32:1017-1021. [PMID: 29405481 PMCID: PMC6001524 DOI: 10.1111/jdv.14843] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 01/22/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND The current gold standard for diagnosing onychomycosis is direct microscopic examination and culturing. Fungal culture is a time-consuming procedure, while direct microscopy of potassium hydroxide (KOH) mounts suffers from low sensitivity. More rapid and sensitive methods for the diagnosis of onychomycosis are in high demand. OBJECTIVE To establish an effective method for the diagnosis of onychomycosis by assessing the efficacies of fungal fluorescent staining and internal transcribed spacer (ITS) ribosomal DNA (rDNA) polymerase chain reaction (PCR)-based sequencing. METHODS A total of 204 clinical specimens from patients with suspected onychomycosis were analysed. The gold standard for a true positive sample was positive by KOH, culturing or both methods. All specimens were also tested by fungal fluorescent staining and ITS rDNA PCR-based sequencing. We compared the detection, sensitivity and specificity for these two methods with conventional methods. RESULTS In total, 126 (62%) and 102 (50%) were detected by fluorescent staining and PCR-based sequencing, respectively. According to the conventional diagnostic standard, the sensitivity of fluorescent staining and PCR-based sequencing was 97% and 78%, respectively, and specificities of 89% and 90%, respectively. Use of fluorescence enhanced the sensitivity of direct examination by 12% compared with KOH. PCR-based sequencing increased the sensitivity by 6% compared with culturing. CONCLUSIONS Fluorescence microscopy has a higher sensitivity for the detection of fungi in nail specimens compared with KOH and can be used as a rapid screening tool. PCR-based sequencing was faster and more sensitive compared with culture and when used in conjunction with fluorescence microscopy resulted in higher efficiency.
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Affiliation(s)
- F Bao
- Shandong Provincial Hospital for Skin Diseases, Shandong University, Jinan, Shandong, China.,Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, Jinan, Shandong, China.,Shandong Provincial Key Lab for Dermatovenereology, Jinan, Shandong, China
| | - Y Fan
- Department of Toxicological and Functional Test, Shandong Centers for Disease Control and Prevention, Jinan, Shandong, China
| | - L Sun
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, Jinan, Shandong, China.,Shandong Provincial Key Lab for Dermatovenereology, Jinan, Shandong, China
| | - Y Yu
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, Jinan, Shandong, China.,Shandong Provincial Key Lab for Dermatovenereology, Jinan, Shandong, China
| | - Z Wang
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, Jinan, Shandong, China.,Shandong Provincial Key Lab for Dermatovenereology, Jinan, Shandong, China
| | - Q Pan
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, Jinan, Shandong, China.,Shandong Provincial Key Lab for Dermatovenereology, Jinan, Shandong, China
| | - C Yu
- Shandong Provincial Hospital for Skin Diseases, Shandong University, Jinan, Shandong, China.,Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, Jinan, Shandong, China.,Shandong Provincial Medical Center for Dermatovenereology, Jinan, Shandong, China
| | - H Liu
- Shandong Provincial Hospital for Skin Diseases, Shandong University, Jinan, Shandong, China.,Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, Jinan, Shandong, China.,Shandong Provincial Key Lab for Dermatovenereology, Jinan, Shandong, China
| | - F Zhang
- Shandong Provincial Hospital for Skin Diseases, Shandong University, Jinan, Shandong, China.,Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, Jinan, Shandong, China.,Shandong Provincial Key Lab for Dermatovenereology, Jinan, Shandong, China.,Shandong Provincial Medical Center for Dermatovenereology, Jinan, Shandong, China
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Challenges and Solution of Invasive Aspergillosis in Non-neutropenic Patients: A Review. Infect Dis Ther 2017; 7:17-27. [PMID: 29273978 PMCID: PMC5840102 DOI: 10.1007/s40121-017-0183-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Indexed: 12/31/2022] Open
Abstract
Invasive aspergillosis (IA) is a serious opportunistic infection, which has increasingly been recognized as an emerging disease of non-neutropenic patients. In this group of patients, the diagnosis of IA can be challenging owing to the lack of specificity of symptoms, the difficulty in discriminating colonization from infection, and the lower sensitivity of microbiological and radiological tests compared with immunocompromised patients. The aim of this article is to present to clinicians a critical review on the management of IA in non-neutropenic patients.
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13
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Cao GJ, Xing ZF, Hua L, Ji YH, Sun JB, Zhao Z. Evaluation of the diagnostic performance of panfungal polymerase chain reaction assay in invasive fungal diseases. Exp Ther Med 2017; 14:4208-4214. [PMID: 29104637 PMCID: PMC5658737 DOI: 10.3892/etm.2017.5081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 06/02/2017] [Indexed: 11/12/2022] Open
Abstract
Timely diagnosis of invasive fungal diseases (IFDs) is important, as delays in treatment initiation are associated with increased mortality rates. However, early diagnosis of IFDs in immunocompromised patients remains difficult. The conventional diagnostic methods currently used for IFDs are not sufficiently effective. Molecular tests, such as polymerase chain reaction (PCR)-based assays, have great potential to improve the early diagnosis of IFDs due to their sensitivity and specificity. In the present study, the diagnostic performance of panfungal PCR assays in IFD patients who received bone marrow transplantation was evaluated. The results suggested that panfungal PCR assay offered a quick and convenient guide for clinical decision-making by identifying higher numbers of fungal species in comparison with the conventional blood culture method. Furthermore, panfungal PCR assay exhibited a sensitivity of 93% and a specificity of 71% in the diagnosis of IFD patients based on the EORTC/MSG criteria. Thus, the present study concluded that the reported PCR-based method was effective and sensitive in early IFD diagnosis and should be integrated into clinical decision-making for the treatment of IFDs in the future.
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Affiliation(s)
- Guo-Jun Cao
- Department of Laboratory Medicine, Huashan Hospital, Fudan University, Shanghai 200040, P.R. China
| | - Zhi-Fang Xing
- Department of Blood Transfusion, Minhang Hospital, Fudan University, Shanghai 201199, P.R. China
| | - Li Hua
- Department of Clinical Laboratory, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, P.R. China
| | - Yu-Hua Ji
- Department of Clinical Laboratory, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, P.R. China
| | - Jia-Bin Sun
- Department of Clinical Laboratory, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, P.R. China
| | - Zhen Zhao
- Department of Clinical Laboratory, Minhang Hospital, Fudan University, Shanghai 201199, P.R. China
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14
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15
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Zaragoza R, Ferrer R, Llinares P, Maseda E, Rodríguez A, Grau S, Quindós G. EPICO 4.0. 'Total quality' in the management of invasive candidiasis in critically ill patients by analysing the integrated process. Rev Iberoam Micol 2017; 34:143-157. [PMID: 28734773 DOI: 10.1016/j.riam.2017.03.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 03/12/2017] [Accepted: 03/30/2017] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND A high quality integrated process in the clinical setting of non-neutropenic critically ill patients at risk for invasive candidiasis is a necessary tool to improve the management of these patients. AIMS To identify the key points on invasive candidiasis in order to develop a set of recommendations with a high level of consensus required for the creation of a total quality integrated process for the management of non-neutropenic critically ill patients at risk of invasive candidiasis. METHODS After a thorough review of the literature of the previous five years, a Spanish prospective questionnaire, which measured consensus by the Delphi technique, was anonymously conducted by e-mail, including 31 national multidisciplinary experts with extensive experience in invasive fungal infections, from six national scientific societies. The experts included a specialist in intensive care medicine, anesthetists, microbiologists, pharmacologists, and specialists in infectious diseases that responded 27 questions prepared by the coordination group. The educational objectives considered six processes that included knowledge of the local epidemiology, the creation and development of multidisciplinary teams, the definitions of the process, protocols, and indicators (KPI), an educational phase, hospital implementation, and the measurement of outcomes. The level of agreement among experts in each category to be selected should exceed 70%. In a second phase, after drawing up the recommendations of the selected processes, a face to face meeting with more than 60 specialists was held. The specialists were asked to validate the pre-selected recommendations. MEASURES AND MAIN OUTCOMES Firstly, 20 recommendations from all the sections were pre-selected: Knowledge of local epidemiology (3 recommendations), creation and development of multidisciplinary teams (3), definition of the process, protocols and indicators (1), educational phase (3), hospital implementation (3), and measurement of outcomes (7). After the second phase, 18 recommendations were validated, and it was concluded that the minimum team or core necessary for the development of an efficient program in the use of antifungal drugs in non-neutropenic critically ill patients must consist of a specialist in infectious diseases, a clinical pharmacist, a microbiologist, a specialist in intensive care medicine, a specialist in anesthesia and recovery, and an administrator or member of the medical management team, and, in order to be cost-effective, it should be implemented in hospitals with over 200 beds. In addition, it is recommended to apply a consensual check list for the evaluation of the diagnostic process and treatment of invasive candidiasis in patients that have started an antifungal treatment. The management of external knowledge and individual learning stand out as active educational strategies. The main strategies for measuring patient safety outcomes are the analysis of the results achieved, and learning activities; assess, review and refine the deployment of the processes; quality control; epidemiological surveillance and applied research; benchmarking; and basic research. The results of the integrated process should be annually disseminated outside the hospital. CONCLUSIONS Optimizing the management of invasive candidiasis requires the application of the knowledge and skills detailed in our recommendations. These recommendations, based on the Delphi methodology, facilitate the creation of a total quality integrated process in critically-ill patients at risk for invasive candidiasis.
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Affiliation(s)
- Rafael Zaragoza
- Unidad de Sepsis, Medicina Intensiva, Hospital Universitario Dr. Peset, Valencia, Spain.
| | - Ricard Ferrer
- Servicio de Medicina Intensiva, Hospital Universitario Valle de Hebrón, Barcelona, Spain
| | - Pedro Llinares
- Unidad de Enfermedades Infecciosas, Complejo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain
| | - Emilio Maseda
- Servicio de Anestesiología y Reanimación, Hospital Universitario La Paz, Madrid, Spain
| | - Alejandro Rodríguez
- Unidad de Cuidados Intensivos, Hospital Universitario Juan XXIII, Tarragona, Spain
| | - Santiago Grau
- Servicio de Farmacia, Hospital del Mar, Barcelona, Spain
| | - Guillermo Quindós
- Departamento de Inmunología, Microbiología y Parasitología, Facultad de Medicina y Odontología, Universidad del País Vasco (UPV/EHU), Bilbao, Vizcaya, Spain
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16
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Antibodies against a β-glucan-protein complex of Candida albicans and its potential as indicator of protective immunity in candidemic patients. Sci Rep 2017; 7:2722. [PMID: 28578431 PMCID: PMC5457410 DOI: 10.1038/s41598-017-02977-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 04/20/2017] [Indexed: 01/24/2023] Open
Abstract
Sera from candidemic and non-candidemic subjects were examined for antibodies against the cell wall β1,3- and β1,6-glucans, as well as the β-glucan-associated protein MP65 of Candida species. Although antibodies against each of the above components were detected in all subjects, candidemic patients had lower antibody titers against β1,3-glucan, but higher antibody titers against β1,6-glucan and MP65, than non-candidemic subjects. The elevated levels of anti-β1,6-glucan and -MP65 antibodies found in candidemic patients were independent on the patient risk category, APACHE II score, presence of co-morbidities, β1,3-glucanemia level, Candida isolate, and antifungal treatment. Interestingly, however, the anti-MP65, but not the anti-β1,6-glucan antibodies, of candidemic patients had higher titers in survivors than in non-survivors, particularly in those subject categories with the highest mortality (>65-years old, diabetic, or septic shock patients). Thus, candidemic patients are capable of boosting anti-Candida immune responses upon infection, and some of these responses might be associated to the generation of protective immunity in patients with candidemia.
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17
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Heldt S, Hoenigl M. Lateral Flow Assays for the Diagnosis of Invasive Aspergillosis: Current Status. CURRENT FUNGAL INFECTION REPORTS 2017; 11:45-51. [PMID: 28680526 PMCID: PMC5487869 DOI: 10.1007/s12281-017-0275-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW Diagnosis during early stages of invasive aspergillosis (IA) and targeted antifungal treatment has the potential to improve survival significantly. Despite advances in the diagnostic arsenal, invasive mold infections remain difficult to diagnose-especially at early stages before typical radiological signs develop. Varying availability and time-to-results are important limitations of current approved biomarkers and molecular assays for diagnosis of IA. Here, we will give an update on the Aspergillus-specific lateral-flow device (LFD) test. We further review promising findings on feasibility of point-of-care (POC) detection of urinary excreted fungal galactomannan-like antigens. RECENT FINDINGS POC LFD assays for detection of Aspergillus antigens are currently in development. The Aspergillus-specific LFD test, which is based on the JF5 antibody (Ab), detects an extracellular glycoprotein antigen secreted during active growth of Aspergillus spp. The test has shown promising results in various studies. In addition, a monoclonal Ab476-based LFD for POC detection of urinary excreted fungal galactomannan-like antigens has been developed but needs further validation. SUMMARY Important advances have been made in the development of LFD assays for IA. Most promising is the Aspergillus-specific LFD test; commercial availability is still pending, however. The search for reliable POC tests for other molds, including mucorales, continues.
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Affiliation(s)
- Sven Heldt
- Division of Pulmonology, Medical University of Graz, Graz, Austria
| | - Martin Hoenigl
- Division of Pulmonology, Medical University of Graz, Graz, Austria
- Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
- CBmed—Center for Biomarker Research in Medicine, Graz, Austria
- Division of Infectious Diseases, Department of Medicine, University of California–San Diego, San Diego, USA
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18
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Rakita RM, O'Brien KD, Bourassa L. Diaporthe soft tissue infection in a heart transplant patient. Transpl Infect Dis 2017; 19. [PMID: 28207190 DOI: 10.1111/tid.12680] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 10/15/2016] [Accepted: 11/20/2016] [Indexed: 12/01/2022]
Abstract
Infections caused by Diaporthe species are very uncommon. We describe a heart transplant recipient 14 years post transplant who developed a soft tissue fungal infection due to a Diaporthe species that responded well to surgical excision and posaconazole therapy. The Aspergillus galactomannan index was markedly elevated, and returned to normal following treatment. Solid organ transplant patients remain at risk of infection long after transplantation and should be counseled about risk avoidance.
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Affiliation(s)
- Robert M Rakita
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Kevin D O'Brien
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Lori Bourassa
- Department of Laboratory Medicine, University of Washington, Seattle, WA, USA
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19
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Case Series Study of Invasive Pulmonary Aspergillosis. Mycopathologia 2016; 182:505-515. [DOI: 10.1007/s11046-016-0097-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 11/21/2016] [Indexed: 10/20/2022]
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20
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León C, Ruiz-Santana S, Saavedra P, Castro C, Loza A, Zakariya I, Úbeda A, Parra M, Macías D, Tomás JI, Rezusta A, Rodríguez A, Gómez F, Martín-Mazuelos E. Contribution of Candida biomarkers and DNA detection for the diagnosis of invasive candidiasis in ICU patients with severe abdominal conditions. Crit Care 2016; 20:149. [PMID: 27181045 PMCID: PMC4867537 DOI: 10.1186/s13054-016-1324-3] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 04/26/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To assess the performance of Candida albicans germ tube antibody (CAGTA), (1 → 3)-ß-D-glucan (BDG), mannan antigen (mannan-Ag), anti-mannan antibodies (mannan-Ab), and Candida DNA for diagnosing invasive candidiasis (IC) in ICU patients with severe abdominal conditions (SAC). METHODS A prospective study of 233 non-neutropenic patients with SAC on ICU admission and expected stay ≥ 7 days. CAGTA (cutoff positivity ≥ 1/160), BDG (≥80, 100 and 200 pg/mL), mannan-Ag (≥60 pg/mL), mannan-Ab (≥10 UA/mL) were measured twice a week, and Candida DNA only in patients treated with systemic antifungals. IC diagnosis required positivities of two biomarkers in a single sample or positivities of any biomarker in two consecutive samples. Patients were classified as neither colonized nor infected (n = 48), Candida spp. colonization (n = 154) (low-grade, n = 130; high-grade, n = 24), and IC (n = 31) (intra-abdominal candidiasis, n = 20; candidemia, n = 11). RESULTS The combination of CAGTA and BDG positivities in a single sample or at least one of the two biomarkers positive in two consecutive samples showed 90.3 % (95 % CI 74.2-98.0) sensitivity, 42.1 % (95 % CI 35.2-98.8) specificity, and 96.6 % (95 % CI 90.5-98.8) negative predictive value. BDG positivities in two consecutive samples had 76.7 % (95 % CI 57.7-90.1) sensitivity and 57.2 % (95 % CI 49.9-64.3) specificity. Mannan-Ag, mannan-Ab, and Candida DNA individually or combined showed a low discriminating capacity. CONCLUSIONS Positive Candida albicans germ tube antibody and (1 → 3)-ß-D-glucan in a single blood sample or (1 → 3)-ß-D-glucan positivity in two consecutive blood samples allowed discriminating invasive candidiasis from Candida spp. colonization in critically ill patients with severe abdominal conditions. These findings may be helpful to tailor empirical antifungal therapy in this patient population.
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Affiliation(s)
- Cristóbal León
- Intensive Care Unit, Hospital Universitario de Valme, Universidad de Sevilla, Avenida Bellavista s/n, 41014, Sevilla, Spain.
| | - Sergio Ruiz-Santana
- Intensive Care Unit, Hospital Universitario Dr. Negrín, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Pedro Saavedra
- Mathematics Department, Universidad de las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Carmen Castro
- Clinical Unit of Microbiology and Infectious Diseases, Hospital Universitario de Valme, Universidad de Sevilla, Sevilla, Spain
| | - Ana Loza
- Intensive Care Unit, Hospital Universitario de Valme, Universidad de Sevilla, Avenida Bellavista s/n, 41014, Sevilla, Spain
| | - Ismail Zakariya
- Clinical Unit of Microbiology and Infectious Diseases, Hospital Universitario de Valme, Universidad de Sevilla, Sevilla, Spain
| | - Alejandro Úbeda
- Intensive Care Unit, Hospital Punta de Europa, Algeciras, Cádiz, Spain
| | - Manuel Parra
- Clinical Unit of Microbiology and Infectious Diseases, Hospital Universitario de Valme, Universidad de Sevilla, Sevilla, Spain
| | - Desirée Macías
- Intensive Care Unit, Hospital Universitario de Valme, Universidad de Sevilla, Avenida Bellavista s/n, 41014, Sevilla, Spain
| | - José Ignacio Tomás
- Intensive Care Unit, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Antonio Rezusta
- Service of Microbiology, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Alejandro Rodríguez
- Critical Care Department, Hospital Universitari Joan XXIII, Tarragona, Spain
| | - Frederic Gómez
- Service of Microbiology, Hospital Universitari Joan XXIII, Tarragona, Spain
| | - Estrella Martín-Mazuelos
- Clinical Unit of Microbiology and Infectious Diseases, Hospital Universitario de Valme, Universidad de Sevilla, Sevilla, Spain
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21
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Reischies FMJ, Prattes J, Woelfler A, Eigl S, Hoenigl M. Diagnostic performance of 1,3-beta-D-glucan serum screening in patients receiving hematopoietic stem cell transplantation. Transpl Infect Dis 2016; 18:466-70. [PMID: 26992092 DOI: 10.1111/tid.12527] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Revised: 01/08/2016] [Accepted: 01/20/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND The polysaccharide cell wall component, 1,3-beta-D-glucan (BDG), is used as a serum biomarker for invasive fungal infection (IFI). Patients receiving hematopoietic stem cell transplantation (HSCT) are considered a highly vulnerable group for IFI development. We evaluated the diagnostic performance of serum BDG screening in HSCT recipients. METHODS HSCT recipients were prospectively enrolled in this study between September 2014 and August 2015. Routine serum BDG screening was performed 2-3 times weekly by using the Fungitell(®) assay. All samples were classified according to the 2008 EORTC/MSG criteria, with serum BDG results not being considered for classification. The diagnostic performance of BDG testing for IFI was calculated. BDG values ≥80 pg/mL were considered positive. RESULTS A total of 308 serum samples were collected in 45 patients. The majority of 172 samples (55.8%) were obtained at the early phase (within 30 days) after allogeneic HSCT. BDG levels were significantly higher in 16 possible/probable IFI samples when compared to no evidence for IFI samples (median 170 pg/mL, interquartile range [IQR] 100-274 pg/mL vs. median 15 pg/mL, IQR 15-15 pg/mL; P < 0.001, Mann-Whitney U-test). Diagnostic performance of serum BDG screening for possible IFI/probable invasive pulmonary aspergillosis vs. no evidence for IFI was as follows: sensitivity 81%, specificity 98%, positive predictive value 65%, negative predictive value (NPV) 99%, and diagnostic odds ratio 176 (95% confidence interval 41-761). CONCLUSIONS Our data suggest that serum BDG testing in HSCT patients may be highly specific and associated with a very high NPV of >99%. Therefore, serum BDG may be a helpful tool to rule out IFI in HSCT patients.
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Affiliation(s)
- F M J Reischies
- Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, Graz, Austria
| | - J Prattes
- Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, Graz, Austria.,Center for Biomarker Research in Medicine, Graz, Austria
| | - A Woelfler
- Division of Hematology, Medical University of Graz, Graz, Austria
| | - S Eigl
- Division of Pulmonology, Medical University of Graz, Graz, Austria
| | - M Hoenigl
- Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, Graz, Austria.,Center for Biomarker Research in Medicine, Graz, Austria.,Division of Pulmonology, Medical University of Graz, Graz, Austria.,Division of Infectious Diseases, Department of Medicine, University of California-San Diego, San Diego, CA, USA
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22
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Duettmann W, Koidl C, Krause R, Lackner G, Woelfler A, Hoenigl M. Specificity of mannan antigen and anti-mannan antibody screening in patients with haematological malignancies at risk for fungal infection. Mycoses 2016; 59:374-8. [PMID: 26916753 DOI: 10.1111/myc.12482] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 01/15/2016] [Accepted: 01/23/2016] [Indexed: 12/28/2022]
Abstract
Combination of mannan antigen and anti-mannan antibody (Mn/A-Mn) testing has been reported a useful and specific strategy for diagnosis of invasive Candida infections (ICIs). We evaluated Mn/A-Mn as a screening tool in patients with haematological malignancies. This clinical prospective study was performed at the Division of Hematology, Medical University Graz, Austria between July and December 2012. Patients at risk for fungal infection were included into the study and twice weekly screened by Mn/A-Mn testing, yielding 650 samples. Of overall 67 patients 66 had no evidence for ICI. From those, 153/640 serum samples (23.9%) were positive for mannan Ab, and nine (1.4%) for Ag. Most false positive Ab results were observed among 375 samples from patients without haematopoietic stem cell transplantation (34.9% resulted positive). Combined specificity of Mn/A-Mn was 74.8%. Of 10 samples obtained in the single patient with candidemia, five were positive for mannan Ag (from the day of diagnosis up to 40 days after detection of candidemia) and none for Ab. In conclusion, mannan Ab screening yielded a high number of false positive results. While mannan Ag was found to be highly specific and may have potential for diagnostic driven testing, mannan Ab testing cannot be recommended based on our study results.
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Affiliation(s)
- Wiebke Duettmann
- Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, Graz, Austria.,Division of Hematology, Medical University of Graz, Graz, Austria
| | - Christoph Koidl
- Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Graz, Austria
| | - Robert Krause
- Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, Graz, Austria
| | - Gertrude Lackner
- Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Graz, Austria
| | - Albert Woelfler
- Division of Hematology, Medical University of Graz, Graz, Austria
| | - Martin Hoenigl
- Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, Graz, Austria.,Division of Infectious Diseases, Department of Medicine, University of California-San Diego, San Diego, CA, USA.,Division of Pulmonology, Medical University of Graz, Graz, Austria
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