P Pini1,2, C Bettua1, C F Orsi3,4, C Venturelli1, F Forghieri5, S Bigliardi5, L Faglioni5, F Luppi6, L Serio7, M Codeluppi8, M Luppi5, C Mussini8, M Girardis7, Elisabetta Blasi9. 1. Dipartimento Interaziendale Integrato di Medicina di Laboratorio e Anatomia Patologica, Struttura Complessa di Microbiologia e Virologia, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy. 2. Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy. 3. Dipartimento di Medicina Diagnostica, Clinica e di Sanità Pubblica, Istituti Biologici, Università di Modena e Reggio Emilia, Via Campi 287, 41125, Modena, Italy. 4. Dipartimento di Scienze della Salute, Università di Milano, Polo Universitario San Paolo, Milan, Italy. 5. Dipartimento Attività Integrata di Oncologia, Ematologia e Patologie dell'Apparato Respiratorio, Ematologia, Azienda Ospedaliero-Universitaria Policlinico, Università di Modena e Reggio Emilia, Modena, Italy. 6. Dipartimento Attività Integrata di Oncologia, Ematologia e Patologie dell'Apparato Respiratorio, Malattie dell'Apparato Respiratorio, Università di Modena e Reggio Emilia, Modena, Italy. 7. Divisione di Anestesiologia e Terapia Intensiva, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy. 8. Dipartimento Attività Integrata di Medicine, Medicina d'Urgenza e Specialità Mediche, Malattie infettive, Università di Modena e Reggio Emilia, Modena, Italy. 9. Dipartimento di Medicina Diagnostica, Clinica e di Sanità Pubblica, Istituti Biologici, Università di Modena e Reggio Emilia, Via Campi 287, 41125, Modena, Italy. elisabetta.blasi@unimore.it.
Abstract
PURPOSE: We investigated the clinical performance of (1 → 3)-β-D-glucan (BG), as an early marker of invasive fungal infections (IFI), in different clinical settings. METHODS: BG serum levels were assessed by Fungitell (Associates of Cape Cod, Inc), in parallel with galactomannan (GM) when requested by clinicians. By a prospective monocentric study, 270 episodes at risk or with suspect of IFI were enrolled, namely 58 proven-probable invasive aspergillosis (IA), 27 proven invasive candidiasis (IC), 11 possible IC, 16 P.jirovecii pneumonia (PJP), 4 episodes of other IFI and 154 non-IFI controls. RESULTS: We found that (a) the BG overall sensitivity, specificity, positive predictive value and negative predictive value (NPV) were 87.9, 80.5, 76.7 and 89.9 %, respectively; (b) the highest sensitivity was found in the IC groups, followed by PJP, IA and other IFI groups; (c) an association was observed between BG kinetics and patients outcome; (d) in the IA episodes, the combination of BG or GM vs GM alone increased sensitivity from 60.0 to 83.3 % in the haematological patients; (e) false-positive BG results were related to Gram-negative infections or infusion of polyclonal IgM-enriched immunoglobulins, where high levels of BG were indeed detected. CONCLUSION: Besides strengthening its overall good clinical performance, we provide evidence that serum BG correlates with clinical outcome and that, once used in combination with GM, BG allows to enhance IFI diagnosis rate. The high sensitivity and NPV, observed in the Intensive Care Unit setting, open to BG validation as a marker for assessment of antifungal treatment.
PURPOSE: We investigated the clinical performance of (1 → 3)-β-D-glucan (BG), as an early marker of invasive fungal infections (IFI), in different clinical settings. METHODS:BG serum levels were assessed by Fungitell (Associates of Cape Cod, Inc), in parallel with galactomannan (GM) when requested by clinicians. By a prospective monocentric study, 270 episodes at risk or with suspect of IFI were enrolled, namely 58 proven-probable invasive aspergillosis (IA), 27 proven invasive candidiasis (IC), 11 possible IC, 16 P.jiroveciipneumonia (PJP), 4 episodes of other IFI and 154 non-IFI controls. RESULTS: We found that (a) the BG overall sensitivity, specificity, positive predictive value and negative predictive value (NPV) were 87.9, 80.5, 76.7 and 89.9 %, respectively; (b) the highest sensitivity was found in the IC groups, followed by PJP, IA and other IFI groups; (c) an association was observed between BG kinetics and patients outcome; (d) in the IA episodes, the combination of BG or GM vs GM alone increased sensitivity from 60.0 to 83.3 % in the haematological patients; (e) false-positive BG results were related to Gram-negative infections or infusion of polyclonal IgM-enriched immunoglobulins, where high levels of BG were indeed detected. CONCLUSION: Besides strengthening its overall good clinical performance, we provide evidence that serum BG correlates with clinical outcome and that, once used in combination with GM, BG allows to enhance IFI diagnosis rate. The high sensitivity and NPV, observed in the Intensive Care Unit setting, open to BG validation as a marker for assessment of antifungal treatment.
Authors: P Pini; C Bettua; C F Orsi; C Venturelli; L Faglioni; F Forghieri; S Bigliardi; F Luppi; M Girardis; E Blasi Journal: Eur J Clin Microbiol Infect Dis Date: 2014-08-01 Impact factor: 3.267
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Authors: Sigrid Bülow; Robert Heyd; Martina Toelge; Katharina U Ederer; Annette Schweda; Stefan H Blaas; Okka W Hamer; Andreas Hiergeist; Jürgen J Wenzel; André Gessner Journal: J Fungi (Basel) Date: 2020-11-20