Early Diagnosis of Invasive Aspergillosis in Hematological Patients Using a PCR-ELISA Assay: A Prospective Validation.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 3833-3833
Author(s):  
Muriel Cornet ◽  
Sandrine Katsahian ◽  
Anne Vekhoff ◽  
Vincent Levy ◽  
Bernard Rio ◽  
...  
Keyword(s):  
Early Diagnosis ◽  
Invasive Aspergillosis ◽  
Chest Ct ◽  
Elisa Assay ◽  
Cell Transplant ◽  
Predictive Values ◽  
Hematological Patients ◽  
Combined Test ◽  
Risk Treatment ◽  
Sensitivity Specificity

Abstract Purpose: Prospective evaluation of a PCR-ELISA method for the early diagnosis of invasive aspergillosis (IA) in hematological patients. Patients and Methods: The PCR-ELISA assay was evaluated using 1,494 sera samples from 201 hematological adult patients. Monitoring was performed twice weekly during 256 consecutive high-risk treatment periods. Results: Underlying diseases were acute leukemia 52.7%, lymphoma 20.9%, multiple myeloma 12.4%. Eighty four patients (41.8%) were stem cell transplant recipients. Fifty-five patients were diagnosed with IA. PCR-ELISA positivity (i) preceded the empirical antifungal therapy in 20/31 patients (median 10.5 days), (ii) preceded or was simultaneous to the radiological diagnosis by chest CT in 21/31 patients (median 8 days), (iii) preceded the mycological/histological diagnosis in 7/12 patients (median 70 days) and, (iv) anticipated or was simultaneous to the galactomannan (GM) antigen positivity in 50% (median 16.5 days) and in 89 % of the patients (median 33 days) using a 0.5 and a 1.5 optical density index (ODI) cut-off for the GM assay, respectively. For at least two positive samples the sensitivity, specificity, positive and negative predictive values of the PCR-ELISA assay, were 63.6%, 82.2%, 57.4% and 85.7%, respectively. When the PCR-ELISA and GM detections were combined, values of the combined test for at least two positive samples with either assay were 80%, 47.3%, 36.4%, 86.2% using the 0.5 GM ODI cutoff, and 67.3%, 82.2%, 58.7% and 87% using the 1.5 GM ODI cutoff. Conclusion: In addition to serial screening with GM antigenemia and chest CT surveillance, the PCR-ELISA assay may improve the early diagnosis of IA.

scholarly journals Comparison of β-D-Glucan and Galactomannan in Serum for Detection of Invasive Aspergillosis: Retrospective Analysis with Focus on Early Diagnosis

2020 ◽  
Vol 6 (4) ◽  
pp. 253
Author(s):  
Karl Dichtl ◽  
Johannes Forster ◽  
Steffen Ormanns ◽  
Heidi Horns ◽  
Sebastian Suerbaum ◽  
...  
Keyword(s):  
Early Diagnosis ◽  
Invasive Aspergillosis ◽  
Computed Tomography Imaging ◽  
Time Intervals ◽  
Course Of Disease ◽  
Tomography Imaging ◽  
Turbidimetric Assay ◽  
Fungal Biomarkers ◽  
Sensitivity Specificity ◽  
Isolated Species

The early diagnosis of invasive aspergillosis (IA) relies mainly on computed tomography imaging and testing for fungal biomarkers such as galactomannan (GM). We compared an established ELISA for the detection of GM with a turbidimetric assay for detection of the panfungal biomarker β-D-glucan (BDG) for early diagnosis of IA. A total of 226 serum specimens from 47 proven and seven probable IA cases were analysed. Sensitivity was calculated for samples obtained closest to the day of IA-diagnosis (d0). Additional analyses were performed by including samples obtained during the presumed course of disease. Most IA cases involved the respiratory system (63%), and Aspergillus fumigatus was the most frequently isolated species (59%). For proven cases, sensitivity of BDG/GM analysis was 57%/40%. Including all samples dating from –6 to +1 weeks from d0 increased sensitivities to 74%/51%. Sensitivity of BDG testing was as high as or higher than GM testing for all subgroups and time intervals analysed. BDG testing was less specific (90–93%) than GM testing (99–100%). Combining BDG and GM testing resulted in sensitivity/specificity of 70%/91%. Often, BDG testing was positive before GM testing. Our study backs the use of BDG for diagnosis of suspected IA. We suggest combining BDG and GM to improve the overall sensitivity.

Study on Early Diagnosis of Invasive Aspergillosis in Patients with Hematological Diseases.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 4982-4982
Author(s):  
Ai-ning Sun ◽  
Jun Wang ◽  
De Pei Wu ◽  
Su-ning Chen
Keyword(s):  
Early Diagnosis ◽  
Invasive Aspergillosis ◽  
Antifungal Therapy ◽  
Predictive Value ◽  
Elisa Test ◽  
Hematological Disease ◽  
Sensitivity Specificity ◽  
Positive Results ◽  
Test Result ◽  
Pcr Test

Abstract Objective To evaluate the value of galactomannan(GM) detection and nest PCR for early diagnosis of invasive aspergillosis (IA) in patients with hematological disease. Methods GM ELISA and nest PCR was performed to serially screen for circulating galactomannan(GM) and DNA of Aspergillus ssp. Respectively, 96 patients were grouped according to case definitions of the EORTC, including 5 proven IA and 28 probable IA cases. Samples of the patients included serum twice weekly(326) and bronchoalveolar lavage fluid(BALF 12). Sensitivity, specificity and predictive values were calculated respectively and compared. Results According to the receiver operator characteristic curve(ROC), using a reduced cutoff of 0.5 O.D.I of two-positive GM test result, we can achieved the most optimal results. The sensitivity, specificity, positive predictive value (PPV)and negative predictive value (NPV) of the ELISA test were 85.7%,91.6%,85.7%,91.6%respectively. While for the BALF samples, a increased cutoff 1.0 maybe improve the value of this diagnosis, with sensitivity 50% and specificity 100%.Quantitive results of the serum-based GM antigen can represent the status of IA and were correlated with the prognosis Of IA.Galactomannanemia preceded the development of characteristic findings on CT about 6 days. The nest PCR assay amplifies specifically a region of the 18S rRNA gene that is highly conserved in Aspergillus species and allows detection of down to 5.0 fg/ml of Aspergillus DNA. When two-positive results were used to define an episode as ‘PCR positive’, the sensitivity, specificity, PPV and NPV of the PCR test were 92.9%, 100%,100%,96.0% respectively. For the BALF samples, the sensitivity and specificity decreased to 75%and 60%. The frequency of the consecutively positive results of a patient was correlated with prognosis Of IA. The antifungal therapy usually causes a intermittent positive PCR results. Positve PCR results preceded the development of characteristic findings on CT about 9 days. Conclusion The cutoff 0.5 of two-positive serum-based GM ELISA test result is the most optimal cutoff value. GM ELISA test is a rapid,reliable method for early diagnosis and treatment of IA, with good sensitivity(85.7%)and specificity(91.6%). GM ELISA test is a good direction for preemptive antifungal therapy in patients with hematological disease at risk. Using two-positive results to define an episode as ‘PCR positive’, great sensitivity(92.9%)and specificity(100%) could be achieved. The serum-based PCR test is useful for screening for Aspergillus spp. in patients with hematological disease at risk but without antifungal treatment.

scholarly journals Commercial AI solutions in detecting COVID-19 pneumonia in chest CT: not yet ready for clinical implementation?

2021 ◽  
Author(s):  
Florian Jungmann ◽  
Lukas Müller ◽  
Felix Hahn ◽  
Maximilian Weustenfeld ◽  
Ann-Kathrin Dapper ◽  
...  
Keyword(s):  
Sensitivity And Specificity ◽  
Subgroup Analysis ◽  
Chest Ct ◽  
Ground Glass ◽  
Clinical Implementation ◽  
Clinical Routine ◽  
Predictive Values ◽  
Clinical Dataset ◽  
Sensitivity Specificity ◽  
Ct Studies

Abstract Objectives In response to the COVID-19 pandemic, many researchers have developed artificial intelligence (AI) tools to differentiate COVID-19 pneumonia from other conditions in chest CT. However, in many cases, performance has not been clinically validated. The aim of this study was to evaluate the performance of commercial AI solutions in differentiating COVID-19 pneumonia from other lung conditions. Methods Four commercial AI solutions were evaluated on a dual-center clinical dataset consisting of 500 CT studies; COVID-19 pneumonia was microbiologically proven in 50 of these. Sensitivity, specificity, positive and negative predictive values, and AUC were calculated. In a subgroup analysis, the performance of the AI solutions in differentiating COVID-19 pneumonia from other conditions was evaluated in CT studies with ground-glass opacities (GGOs). Results Sensitivity and specificity ranges were 62–96% and 31–80%, respectively. Negative and positive predictive values ranged between 82–99% and 19–25%, respectively. AUC was in the range 0.54–0.79. In CT studies with GGO, sensitivity remained unchanged. However, specificity was lower, and ranged between 15 and 53%. AUC for studies with GGO was in the range 0.54–0.69. Conclusions This study highlights the variable specificity and low positive predictive value of AI solutions in diagnosing COVID-19 pneumonia in chest CT. However, one solution yielded acceptable values for sensitivity. Thus, with further improvement, commercial AI solutions currently under development have the potential to be integrated as alert tools in clinical routine workflow. Randomized trials are needed to assess the true benefits and also potential harms of the use of AI in image analysis. Key Points • Commercial AI solutions achieved a sensitivity and specificity ranging from 62 to 96% and from 31 to 80%, respectively, in identifying patients suspicious for COVID-19 in a clinical dataset. • Sensitivity remained within the same range, while specificity was even lower in subgroup analysis of CT studies with ground-glass opacities, and interrater agreement between the commercial AI solutions was minimal to nonexistent. • Thus, commercial AI solutions have the potential to be integrated as alert tools for the detection of patients with lung changes suspicious for COVID-19 pneumonia in a clinical routine workflow, if further improvement is made.

Comparison of four methods for predicting difficult intubation

2016 ◽  
Vol 5 (01) ◽  
pp. 4720
Author(s):  
Javaher Foroosh Zadeh F ◽  
Safaii Sara
Keyword(s):  
Difficult Intubation ◽  
Elective Surgery ◽  
Upper Lip ◽  
Laryngoscopic View ◽  
Predictive Values ◽  
Significant Difference ◽  
Combined Test ◽  
Predicted Values ◽  
Sensitivity Specificity ◽  
A Prospective Study

Confirmation of endotracheal tube appointment is of critical importance, since unrecognized esophageal intubation can be rapidly lethal (death, brain damage). The aim of our study was to compare four different methods for prediction of difficult intubation: Mallampati, Thyro-mental distance, ULBT (Upper Lip Bite Test), and Inter incisicor gap. In a prospective study, 448 patients with a mean age of 53.5 who were scheduled for elective surgery were selected randomly and enrolled. Before induction of anesthesia, the airways were assessed by Mallampati test, Thyro mental distance, Upper lip bit test(ULBT) and Inter incisor gap. Laryngoscopic view according to the Cormack and Lehane grading system was determined after induction of anesthesia and Grades 3 and 4 defined as “difficult intubation.” Degree of observed difficulty of intubation was compared to predicted values. Sensitivity, specificity, positive and negative predictive values and accuracy of these tests and their combinations with the ULBT were calculated. Statistical analysis was performed using SPSS version 16. Data were analysis by using Fishers exact and McNemar's test, and a Pvalue. <0.05 was considered statistically significant.  The prevalence of difficult intubation Cormack-Lehane in this study was 8.4%, Mallampati test had the highest sensitivity (47.3%) and Thyro-mental distance was most specific (96%). The ULBT (upper lip bite tests) had most positive and negative predictive value (37.9% & 93. 5%).Data also showed that power of these tests in predicting easy intubation is more than their ability in assessing the likelihood of difficult intubation. There was no significant difference regarding difficult intubation based on gender (P < 0.05), whereas there were significant differences between the older tests and laryngeal view (P < 0.05, Mc-Nemar test). Despite the validity of MMP, TMD, ULBT and IIG in predicting easy intubation is much greater than the value in prediction of difficult intubation; however, the simplicity of performing these tests and results of the four tests in evaluating patients before surgery by combination of tests in predicting difficult intubation will likely safe. It seems that best results are from applying combined test than a single one.

Haematological Parameters in Early Diagnosis of Clinically Suspected Neonatal Septicemia

2019 ◽  
Vol 31 (1) ◽  
pp. 65-71
Keyword(s):  
Early Diagnosis ◽  
Late Onset ◽  
Cost Effective ◽  
Haematological Parameters ◽  
Predictive Values ◽  
Neonatal Septicemia ◽  
Mature Neutrophil ◽  
Life Threatening ◽  
Low Sensitivity ◽  
Sensitivity Specificity

Neonatal septicemia is a life-threatening yet treatable condition. It is one of the major health problems throughout the world. Blood culture is the gold standard for diagnosis of neonatal septicemia and should be performed in all cases of suspected septicemia prior to starting antibiotics. But in the present study, the use of the haematological parameters was evaluated to determine the early diagnosis of neonatal septicemia. It was carried out in the neonatal unit of Mandalay Children’s Hospital from September 2012 to August 2013. Out of 68 cases of clinically suspected neonatal septicemia, bacterial pathogens were isolated from 33 cases. Early onset neonatal septicemia was more common than late onset. Among 33 cases of culture-proven neonatal septicemia, septicemia is not likely in 1 case (3%) while borderline for septicemia and septicemia in 6 cases (18.2%) is very likely in 26 cases (78.8%) according to haematological scoring system (HSS). HSS assigns a score of one for each of seven haematological parameters. Out of the seven haematological parameters, immature to total neutrophil ratio (I:T) and immature to mature neutrophil ratio (I:M) were the most reliable test for the neonatal septicemia. Thrombocytopenia had low sensitivity. The haematolgical parameters are simple, quick, cost effective and readily available. The sensitivity, specificity and the predictive values of haematological parameters could be enhanced by combination of these parameters rather than the use of single parameter.

scholarly journals PP13 and PAPP-A in the First and Second Trimesters: Predictive Factors for Preeclampsia?

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Narges Moslemi Zadeh ◽  
Farshad Naghshvar ◽  
Sepideh Peyvandi ◽  
Parand Gheshlaghi ◽  
Sara Ehetshami
Keyword(s):  
Early Diagnosis ◽  
Predictive Factors ◽  
Statistical Tests ◽  
Protein A ◽  
Serum Levels ◽  
Diagnostic Value ◽  
Control Group ◽  
Case Group ◽  
Predictive Values ◽  
Sensitivity Specificity

Background. Preeclampsia affects 5-6% of all pregnancies. Predictive factors of preeclampsia can be helpful in early diagnosis of this disease. In this study the predictive values of biochemical markers placenta protein 13 (PP13) and pregnancy-associated plasma protein A (PAPP-A) have been assessed in early diagnosis of preeclampsia. Methods. This case-control study was conducted on 1500 women who presented to a healthcare center of Sari, Iran, between 2010 and 2011. Blood samples were drawn in weeks 11–13 and 24–28 of pregnancy. Of them who developed preeclampsia were considered as case group. A control group consisted of similar women regarding mean age, body mass index (BMI), and pregnancy age. PAPP-A and PP13 serum levels were measured. Data were analyzed using proper statistical tests. Results. PAPP-A and PP13 serum levels were significantly lower in both the first and second trimesters in women who developed preeclampsia (P<0.001). The cumulative value of all four variables with cut-off point of 238.5 has sensitivity, specificity of 91.0%, and undercurve surface of 0.968 which is the most diagnostic value for preeclampsia. Conclusion. It is possible to advantage measuring of PAPP-A and PP13 in the first and second trimesters especially their cumulative values in both trimesters for prediction of the incidence of preeclampsia.

scholarly journals The Diagnostic Significance of PDGF, EphA7, CCR5, and CCL5 Levels in Colorectal Cancer

Biomolecules ◽  
2019 ◽  
Vol 9 (9) ◽  
pp. 464 ◽  
Author(s):  
Üçüncü ◽  
Serilmez ◽  
Sarı ◽  
Bademler ◽  
Karabulut
Keyword(s):  
Colorectal Cancer ◽  
Early Diagnosis ◽  
Colorectal Carcinoma ◽  
Area Under The Curve ◽  
Control Group ◽  
Healthy Controls ◽  
Diagnostic Significance ◽  
Predictive Values ◽  
Sensitivity Specificity ◽  
Potential Biomarkers

In this study, we compared the levels of C-C chemokine receptor type 5 (CCR5), C-C motif chemokine ligand 5 (CCL5), platelet-derived growth factor (PDGF), and EphrinA7 (EphA7) in patients with colorectal carcinoma and healthy controls in order to investigate the significance and usability of these potential biomarkers in early diagnosis of colorectal cancer. The study included 70 colorectal carcinoma patients and 40 healthy individuals. The CCR5, CCL5, PDGF, and EphA7 levels were measured using ELISA in blood samples. PDGF-BB, EphA7, CCR5, and CCL5 levels of the patients with colorectal carcinoma were significantly higher compared to the control group (p < 0.001 for each comparison). Our logistic regression analysis (the area under the curve was 0.958) supports the notion that PDGF-BB, EphA7, and CCL5 are potential biomarkers for the diagnosis of colon cancer. The sensitivity, specificity, and positive and negative predictive values were found to be 87.9%, 87.5%, 92.1%, and 81.4%, respectively. To our knowledge, this is the first study that investigates the relationship between colorectal carcinoma and the four biomarkers CCL5, CCR5, PDGF, and EphA7. The significantly elevated levels of all these parameters in the patient group compared to the healthy controls indicate that they can be used for the early diagnosis of colorectal carcinoma.

scholarly journals Performance, Correlation and Kinetic Profile of Circulating Serum Fungal Biomarkers of Invasive Aspergillosis in High-Risk Patients with Hematologic Malignancies

2021 ◽  
Vol 7 (3) ◽  
pp. 211
Author(s):  
Maria Siopi ◽  
Stamatis Karakatsanis ◽  
Christoforos Roumpakis ◽  
Konstantinos Korantanis ◽  
Elina Eldeik ◽  
...  
Keyword(s):  
High Risk ◽  
Invasive Aspergillosis ◽  
Patient Characteristics ◽  
Hematologic Malignancies ◽  
Diagnostic Tools ◽  
Predictive Values ◽  
High Risk Patients ◽  
Risk Patients ◽  
Fungal Biomarkers ◽  
Sensitivity Specificity

As conventional microbiological documentation of invasive aspergillosis (IA) is difficult to obtain, serum fungal biomarkers are important adjunctive diagnostic tools. Positivity rates and the kinetic profiles of galactomannan (GM), 1,3-β-D-glucan (BDG) and Aspergillus DNA (PCR) were studied in high-risk patients with hematologic malignancies. GM, BDG and PCR data from serial serum specimens (n = 240) from 93 adult hematology patients with probable (n = 8), possible (n = 25) and no (n = 60) IA were retrospectively analyzed. Positivity rates and sensitivity/specificity/positive/negative predictive values (NPV) of each fungal biomarker alone and in combination were estimated. The three markers were compared head-to-head and correlated with various biochemical, demographic and patient characteristics. The positivity rates for patients with probable/possible/no IA were 88%/8%/0 % for GM (X2 = 55, p < 0.001), 62%/46%/35% for BDG (X2 = 2.5, p = 0.29), 62%/33%/27% for PCR (X2 = 3.9, p = 0.15), 50%/4%/0% for GM + BDG and GM + PCR (X2 = 31, p < 0.001), 50%/8%/22% for BDG + PCR (X2 = 6.5, p = 0.038) and 38%/4%/0% for GM + BDG + PCR (X2 = 21, p < 0.001). Higher agreement (76%) and negative correlation (rs = -0.47, p = 0.0017) was found between GM index and PCR Ct values. The sensitivity and NPV was 45-55% and 90-92% when biomarkers assessed alone and increased to 75-90% and 93-97%, respectively when combined. Weak significant correlations were found between GM, PCR and BDG results with renal/liver function markers (r = 0.11–0.57) with most GM+ and PCR+ samples found in the first and second week of clinical assessment, respectively and BDG later on. Different positivity rates, time profiles and performances were found for the three biomarkers advocating the combination of GM with PCR for the early diagnosis of IA, whereas the high NPV of combined biomarkerscould help excluding IA.

scholarly journals Comparison of the Accuracy of Thermography and Mammography in the Detection of Breast Cancer

Breast Care ◽  
2016 ◽  
Vol 11 (4) ◽  
pp. 260-264 ◽  
Author(s):  
Ramesh Omranipour ◽  
Ali Kazemian ◽  
Sadaf Alipour ◽  
Masoume Najafi ◽  
Mansour Alidoosti ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Early Diagnosis ◽  
Gold Standard ◽  
Breast Biopsy ◽  
Screening Mammography ◽  
Tissue Sampling ◽  
Predictive Values ◽  
Referral Center ◽  
Medical Centers ◽  
Sensitivity Specificity

Background: Benefits and harms of screening mammography have been disputed in recent years. This fact, along with the limitations of mammography as well as its unavailability in all our medical centers, tempted us to evaluate the accuracy of thermography in detecting breast abnormalities. Patients and Methods: All patients who were candidates for breast biopsy were examined by both mammography and thermography before tissue sampling in a referral center between January 2013 and January 2014. We defined sensitivities and specificities, and positive predictive values (PPVs) and negative predictive values (NPVs), of the 2 modalities in comparison with histologic results as the gold standard. Results: 132 patients were included. The median age of all patients was 49.5 ± 10.3 years (range 24-75 years). The sensitivity, specificity, PPV, NPV, and accuracy for mammography were 80.5%, 73.3%, 85.4%, 66.0%, and 76.9%, respectively, whereas for thermography the figures were 81.6%, 57.8%, 78.9%, 61.9%, and 69.7%, respectively. Conclusion: Our study confirms that, at the present time, thermography cannot substitute for mammography for the early diagnosis of breast cancer.

scholarly journals Five Years’ Evaluation of the BD ProbeTec System for the Direct Molecular Detection of Mycobacterium tuberculosis Complex in Respiratory and Nonrespiratory Clinical Samples

2015 ◽  
Vol 64 (4) ◽  
pp. 391-394 ◽  
Author(s):  
Can Bicmen ◽  
Onur Karaman ◽  
Ayriz T. Gunduz ◽  
Onur F. Erer ◽  
Meral Coskun ◽  
...  
Keyword(s):  
Mycobacterium Tuberculosis ◽  
Early Diagnosis ◽  
Molecular Detection ◽  
Mycobacterium Tuberculosis Complex ◽  
Clinical Samples ◽  
Tuberculosis Complex ◽  
Predictive Values ◽  
Smear Negative ◽  
Sensitivity Specificity ◽  
Culture Negative

In this study, Mycobacterium tuberculosis complex was detected by BD ProbeTec ET system in 4716 respiratory and 167 nonrespiratory samples [mostly (98%) smear negative]. Sensitivity, specificity, positive and negative predictive values were 81.8%, 98.3, 85.1 and 97.9 for respiratory and 100%, 96.2, 64.7 and 100, for nonrespiratory samples, respectively. Among 149 (3.1%) ProbeTec DTB positive and culture negative samples, 72 (65 respiratory and seven nonrespiratory) (48.3%) were recovered from the patients who were evaluated as having TB infection. The system has been found as useful in early diagnosis of tuberculosis infection in association with the clinical, radiological and histopathological findings.

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