scholarly journals Difficulties in using 1,3-β-d-glucan as the screening test for the early diagnosis of invasive fungal infections in patients with haematological malignancies – high frequency of false-positive results and their analysis

2010 ◽  
Vol 59 (9) ◽  
pp. 1016-1022 ◽  
Author(s):  
Zdenek Racil ◽  
Iva Kocmanova ◽  
Martina Lengerova ◽  
Barbora Weinbergerova ◽  
Lucie Buresova ◽  
...  
Keyword(s):  
Fungal Infections ◽  
Screening Method ◽  
Invasive Fungal Infections ◽  
Haematological Malignancies ◽  
Serum Samples ◽  
Assay Performance ◽  
Patients At Risk ◽  
Anticancer Treatment ◽  
Positive Results ◽  
Limited Usefulness

We have evaluated the contribution of the 1,3-β-d-glucan (BG) assay for the screening of invasive fungal infections (IFIs) in patients with haematological malignancies. Serum samples from patients at risk of IFI were collected twice a week and retrospectively tested using the BG assay. BG screening was performed on 1143 samples from 91 patients during 104 anticancer treatment cycles. Proven and probable cases of IFI occurred in 9 (8.7 %) treatment cycles. Depending on the criterion of positivity used (1× >60 pg ml−1, 1× >80 pg ml−1, 2× >60 pg ml−1 or 2× >80 pg ml−1) the sensitivity and specificity were 89, 89, 67 and 44 %, and 20, 48, 33 and 56 %, respectively. Although the test was marked as positive in 82, 68, 54 and 45 % of all the treatment cycles, in the majority of cases, these positivities were probably false. The major limit of the BG test was an extremely low positive predictive value (10 to 12 %). We have analysed mucositis, candida colonization, bacteraemia, use of antimicrobials, erythrocyte and thrombocyte filtered blood products, collecting tubes or sampling via venous catheters. Even though no factor is a major source of BG, it could at least partially influence BG assay performance. Thus, BG detection has a limited usefulness as a screening method for IFIs in patients with haematological malignancies.

scholarly journals Efficacy of the new β-D-glucan measurement kit for diagnosing invasive fungal infections, as compared with that of four conventional kits

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0255172
Author(s):  
Yuuki Bamba ◽  
Kei Nagano ◽  
Hiroshi Moro ◽  
Hideyuki Ogata ◽  
Mariko Hakamata ◽  
...  
Keyword(s):  
Measurement Method ◽  
Diagnostic Performance ◽  
Fungal Infections ◽  
Pneumocystis Pneumonia ◽  
Invasive Fungal Infections ◽  
Clinical Samples ◽  
Clinical Diagnoses ◽  
European Regulations ◽  
Pre Treatment ◽  
Positive Results

Background Each of the currently available (1→3)-β-D-glucan (BDG) measurement kits follows a different measurement method and cut-off value. Comparisons of diagnostic performance for invasive fungal infections (IFIs) are desirable. Additionally, ecological considerations are becoming increasingly important in the development of new measurement kits. Methods The plasma BDG levels in clinical samples were measured using the following currently available kits: the Fungitec G test MKII, the Fungitec G test ES, Fungitell, the β-Glucan test Wako, and the newly developed Wako kit (Wako-Eu). Wako-Eu uses a pre-treatment solution that conforms to European regulations for the registration, evaluation, authorisation, and restriction of chemicals. The values obtained for the samples using each kit were studied and compared. Results Of the 165 patients evaluated, 12 had IFIs, including pneumocystis pneumonia, aspergillosis, and candidiasis. BDG values obtained using the kits were moderately correlated with each other. Clinical diagnoses of the evaluated cases indicated that 21 false positives were diagnosed by at least one kit. The sensitivity of the Fungitell kit was relatively low, but those of the other four were over 90%. The specificity was above 90% for all kits. For positive predictive value, the Wako and the Wako-Eu methods were superior to the others owing to fewer false positive results. Conclusions The newly developed Wako-Eu method, which considers ecological concerns, shows diagnostic performance equivalent to that of its predecessor. To improve the diagnostic accuracy of IFIs, it is necessary to interpret the results carefully, giving due consideration to the characteristics of each measurement kit.

scholarly journals Prophylaxis of Invasive Fungal Infections: A Review of the Use of Posaconazole

2009 ◽  
Vol 1 ◽  
pp. CMT.S1948
Author(s):  
Curtis D. Collins ◽  
Jeannina A. Smith ◽  
Daniel R. Kaul
Keyword(s):  
At Risk ◽  
Fungal Pathogens ◽  
Fungal Infections ◽  
Case Reports ◽  
Case Series ◽  
Individual Case ◽  
Invasive Fungal Infections ◽  
Cost Of Care ◽  
Therapeutic Drug ◽  
Patients At Risk

Invasive fungal infections (IFIs) cause significant morbidity, mortality, and increased cost of care in patients with hematological malignancies, prolonged (i.e. >7-10 days) treatment induced neutropenia, and other disease states causing underlying immunosuppression. One strategy often used to combat the development of invasive infections is the use of antifungal agents as prophylaxis in at risk patients. Posaconazole is an oral triazole with a useful spectrum of activity against many fungal pathogens of concern in patients at risk for the development of IFIs. Posaconazole is only available in oral formulation and therapeutic drug monitoring may provide value due to variable absorption and serum concentrations. Clinical efficacy and pharmacoeconomic data have demonstrated the utility of posaconazole in the treatment of oropharyngeal candidiasis and for prophylaxis in patients at risk for development of IFIs. Several organizations or expert groups involved in developing guidelines for the management of IFIs recommend posaconazole anti-fungal prophylaxis in patients with AML or MDS and chemotherapy induced neutropenia or significant GVHD. In addition, nonrandomized studies (largely of salvage therapy) and case series suggest that posaconazole may be effective as treatment for invasive aspergillosis, zygomycosis, and coccidiomycosis. Further, small case series or individual case reports suggest activity against other less commonly encountered filamentous fungi and Histoplasma.

Fungal contamination of water and water-related surfaces in three hospital wards with immunocompromised patients at risk for invasive fungal infections

2010 ◽  
Vol 11 (2) ◽  
pp. 36-41 ◽  
Author(s):  
Julia de Castro Figueiredo Fonseca ◽  
Adel Bouakline ◽  
Jean-Pierre Claisse ◽  
Martine Feuilhade ◽  
André Baruchel ◽  
...  
Keyword(s):  
At Risk ◽  
Fungal Infections ◽  
Invasive Fungal Infections ◽  
Immunocompromised Patients ◽  
Fungal Contamination ◽  
Patients At Risk ◽  
Hospital Wards

Invasive fungal infections are associated with severe depletion of circulating RANTES

2005 ◽  
Vol 54 (11) ◽  
pp. 1017-1022 ◽  
Author(s):  
Michael Ellis ◽  
Basel al-Ramadi ◽  
Ulla Hedström ◽  
Hussain Alizadeh ◽  
Victor Shammas ◽  
...  
Keyword(s):  
T Cell ◽  
Fungal Infection ◽  
Invasive Fungal Infection ◽  
Host Response ◽  
Fungal Infections ◽  
Invasive Fungal Infections ◽  
Time Of Death ◽  
Haematological Malignancies ◽  
Platelet Counts ◽  
The Mean

Serum RANTES (regulated on activation, normal T-cell expressed and secreted) concentrations were measured in 14 patients who had haematological malignancies and developed invasive fungal infections (three of them definite, eight probable and three possible). RANTES levels fell substantially from pre-chemotherapy values at the start of and throughout the fungal infection, and recovered in patients who survived the fungal infection. However, in patients who died from the invasive fungal infection, RANTES levels did not recover. For survivors the mean ± sd levels for RANTES were 7656 ± 877 pg ml−1 on the day prior to chemotherapy, 3723 ± 2443 pg ml−1 on the first day of fungal infection diagnosis (significantly different from baseline; P = 0.001) and 9078 ± 2256 pg ml−1 at recovery from the fungal infection (significantly different from lowest value; P < 0.0001). Platelet counts were closely correlated with the RANTES levels (r = 0.63, P < 0.001). The RANTES concentrations for the three patients who died were similar to those who survived at all equivalent timepoints, but were significantly lower at the time of death (792 ± 877) compared to the values at recovery for survivors (P = 0.005). The finding that patients who died from an invasive fungal infection had very low platelet counts and RANTES concentrations suggests that these could play a role in host response to such infections.

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