J Guitard1, F Isnard2, M-D Tabone3, M Antignac4, E Brissot2, Y Senghor5, A Petit3, G Leverger3, C Hennequin6. 1. AP-HP, Hôpital St Antoine, Service de Parasitologie-Mycologie, 34 rue Crozatier, F-75012 Paris, France; Sorbonne Universités, UPMC Univ Paris 06, Inserm UMR S 1135, CNRS ERL 8255, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), 91 Bd de l'hôpital, F-75013 Paris. Electronic address: juliette.guitard@aphp.fr. 2. AP-HP, Hôpital St Antoine, Service d'Hématologie Clinique, 34 rue Crozatier, F-75012 Paris, France. 3. AP-HP, Hôpital Trousseau-La Roche Guyon, Service d'Hématologie-oncologie pédiatrique, 26 av. du Docteur Arnold-Netter, 75012 Paris, France. 4. AP-HP, Hôpital St Antoine, Pharmacie, 34 rue Crozatier, F-75012 Paris, France. 5. AP-HP, Hôpital St Antoine, Service de Parasitologie-Mycologie, 34 rue Crozatier, F-75012 Paris, France. 6. AP-HP, Hôpital St Antoine, Service de Parasitologie-Mycologie, 34 rue Crozatier, F-75012 Paris, France; Sorbonne Universités, UPMC Univ Paris 06, Inserm UMR S 1135, CNRS ERL 8255, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), 91 Bd de l'hôpital, F-75013 Paris.
Abstract
OBJECTIVES: Definitive diagnosis of invasive candidiasis (IC) may be difficult to achieve in patients with haematological malignancy (PHM). We aimed to evaluate the performance of BDG for the diagnosis and the follow-up of IC in PHM. PATIENTS AND METHODS: We retrospectively reviewed the serological data of BDG assay in adult and paediatric PHM, who developed candidemia or chronic disseminated candidiasis (CDC) through a 4-year period. Sensitivity and kinetics of BDG were determined for both clinical forms. RESULTS: In a panel of 3027 PHM, incidence rates of candidemia and CDC ranged between 0.74 and 0.77 and 0.30 and 0.44 according to the group of patients. At the time of diagnosis, 43.5% and 73% of cases of candidemia and CDC had a positive BDG assay, respectively. We found a significant correlation between the level of BDG at diagnosis and the outcome of candidemia (p = 0.022). In all cases of CDC, BDG negative results were obtained 2 to 6 months before recovery of the CT-scan lesions. CONCLUSIONS: BDG exhibits a low sensitivity to detect IC in PHM, but its kinetics correlates the clinical outcome. Additional studies are warranted in patients with CDC to evaluate the interest of monitoring BDG levels to anticipate the discontinuation of antifungal maintenance therapy.
OBJECTIVES: Definitive diagnosis of invasive candidiasis (IC) may be difficult to achieve in patients with haematological malignancy (PHM). We aimed to evaluate the performance of BDG for the diagnosis and the follow-up of IC in PHM. PATIENTS AND METHODS: We retrospectively reviewed the serological data of BDG assay in adult and paediatric PHM, who developed candidemia or chronic disseminated candidiasis (CDC) through a 4-year period. Sensitivity and kinetics of BDG were determined for both clinical forms. RESULTS: In a panel of 3027 PHM, incidence rates of candidemia and CDC ranged between 0.74 and 0.77 and 0.30 and 0.44 according to the group of patients. At the time of diagnosis, 43.5% and 73% of cases of candidemia and CDC had a positive BDG assay, respectively. We found a significant correlation between the level of BDG at diagnosis and the outcome of candidemia (p = 0.022). In all cases of CDC, BDG negative results were obtained 2 to 6 months before recovery of the CT-scan lesions. CONCLUSIONS:BDG exhibits a low sensitivity to detect IC in PHM, but its kinetics correlates the clinical outcome. Additional studies are warranted in patients with CDC to evaluate the interest of monitoring BDG levels to anticipate the discontinuation of antifungal maintenance therapy.