Clinical value of 1, 3-β-D glucan and mannan IgM/IgG antibodies in the early diagnosis of invasive candidiasis / 中华微生物学和免疫学杂志

Objective:To evaluate the diagnostic value of 1, 3-β-D glucan (BDG), mannan IgM antibody (Mn-IgM) and mannan IgG antibody (Mn-IgG) in invasive candidiasis and to compare the differences in the diagnostic capability of serological markers used alone or in combination.Methods:Serum samples of 126 patients with invasive candidiasis and 104 healthy people who took physical examination during the same period were collected. BDG was detected by dynamic chromogenic method, and Mn-IgM and Mn-IgG were detected by ELISA. The sensitivity, specificity, positive predictive value, negative predictive value, Youden index, coincidence rate and Kappa value of the three serological markers used alone or in combination in the diagnosis of invasive candidiasis were analyzed and compared. The receiver operating characteristic (ROC) curves were drawn and the areas under the curves (AUCs) were calculated.Results:The levels of BDG, Mn-IgM and Mn-IgG in patients with invasive candidiasis were significantly higher than those in healthy people ( P<0.01). The sensitivity, specificity, Kappa value and AUC of BDG were 48.41%, 92.31%, 0.389 and 0.842. The sensitivity, specificity, Kappa value and AUC of Mn-IgM were 64.29%, 91.35%, 0.540 and 0.829. The sensitivity, specificity, Kappa value and AUC of Mn-IgG were 27.78%, 95.19%, 0.214 and 0.737. The sensitivity, specificity, Kappa value and AUC of BDG+ Mn-IgM were 76.19%, 88.46%, 0.637 and 0.921. The sensitivity, specificity, Kappa value and AUC of BDG+ Mn-IgG were 59.52%, 91.35%, 0.491 and 0.856. The sensitivity, specificity, Kappa value and AUC of Mn-IgM+ Mn-IgG were 69.84%, 90.38%, 0.588 and 0.891. The sensitivity, specificity, Kappa value and AUC of BDG+ Mn-IgM+ Mn-IgG were 80.16%, 88.46%, 0.679 and 0.922. Conclusions:The sensitivity of Mn-IgM was higher than that of BDG and Mn-IgG in the diagnosis of invasive candidiasis. When the serological biomarkers were used in combination, BDG+ Mn-IgM and BDG+ Mn-IgM+ Mn-IgG had relatively high Kappa value and AUC, showing high accuracy. The clinical diagnostic value of multiple serological biomarkers used in combination was significantly higher than that of any serological biomarkers used alone. Early combined detection and continuous monitoring of multiple serological biomarkers in patients with high risk of invasive candidiasis could be used clinically to adjust antifungal treatment strategies timely.

Clinical features of Pneumocystis jirovecii pneumonia / 中华检验医学杂志

Objective:The clinical features, laboratory indices, and imaging data of patients with Pneumocystis jirovecii pneumonia (PJP) were described and analyzed, aiming to provide helpful information for the diagnosis and treatment of PJP. Methods:A retrospective study were conducted with data from 154 PJP patients who visited China-Japan Friendship Hospital from May 2017 to August 2020. Their clinical characteristics, laboratory and imaging data, and clinical outcomes were collected for analysis. The patients were further divided into the death group (51 cases) and the survival group(103 cases). The differences between the groups were compared by using t-test, nonparametric test, and chi-square test. Results:Of the 154 PJP patients, there were 89 males and 65 females, with a mean age of (53.7±14.8) years. Among them, 85.7% (132/154) were on immunosuppressive/glucocorticoids agents within the past month. Besides, 27.9% (43/154) and 33.1% (51/154) had kidney diseases and connective tissue diseases, respectively. The major clinical manifestations in these patients involved fever 82.9% (126/154), cough 59.7% (92/154), and dyspnea 52.6% (81/154). For the laboratory data, the lactate dehydrogenase (LDH) was 561.0 (434.3, 749.0) IU/L and the value increased in 91.3% (95/104) of the patients. The CD4+T-cell lymphocytes in 88.0% (95/108) and 57.4% (62/108) of patients were lower than 400/μl and 200/μl, respectively. Furthermore, (1, 3)-β-D glucan (BG) increased in 74.4% (67/90) of PJP patients (≥100.0 ng/L). For the imaging results, chest computed tomography (CT) showed diffuse ground-glass shadows/grid shadows in 90% (117/130) patients. Compared with the survival group, higher LDH [690.5 (528.8, 932.3) IU/L vs 502.5 (381.8, 657.0) IU/L, Z=-3.375, P=0.001], white blood cell count (WBC) [9.8 (5.8, 12.6) ×10 9/L vs 7.3 (5.0, 10.1) ×10 9/L, Z=-2.392, P=0.017], and age [(69.8±14.5) years vs (50.6±14.0) years, t=-3.756, P=0.001] were found in the death group. Lower lymphocyte ratio [5.3 (3.2, 9.3) % vs 9.6 (5.6, 17.2) %, Z=?3.262, P=0.001] and oxygen partial pressure (PaO 2) levels [(73.2±20.5) mmHg vs (64.8±17.7) mmHg (1 mmHg=0.133 kPa), t=2.345, P=0.021] were also observed in the death group. Furthermore, in the death group, the bacterial and fungal infection rate was higher than the rates in the survival group [55.1% (27/51) vs 21.5% (22/103), χ 2=15.372, P=0.001]. Conclusions:Long-term use of immunosuppressive agents or glucocorticoids predispose to PJP. CD4+T-lymphocytes, LDH, and BG might be used as important auxiliary examinations for PJP patients. Age, LDH, WBC, lymphocyte ratio, PaO 2 and possible combinations with bacterial or fungal infections are more closely related to the prognostic of PJP patients.

Clinical value of plasma (1-3)-β-D-glucan for diagnosis of fungal bloodstream infection / 第二军医大学学报

[Abstract] Objective To investigate the clinical value of plasma (1-3)-β-D-glucan test (G test) for diagnosis of fungal bloodstream infection. Methods The blood samples for fungal culturing and G test were collected in Changhai Hospital of Naval Medical University (Second Military Medical University) from Jan. 2015 to Dec. 2017. The department distribution and strain distribution of 264 positive specimens detected by fungal blood culture were analyzed. A total of 1 678 samples were collected during this period for fungal blood culture and plasma G test. Taking fungal blood culture as the criterion, with a cut-off of 100.5 pg/mL for G test, we analyzed the sensitivity, specificity, positive forecast value, and negative forecast value of G test for diagnosis of fungal bloodstream infection. Statistical analysis was performed using SPSS 19.0 software, and the diagnostic value of G test for bloodstream infection was judged by the receiver operating characteristic (ROC) curve. Results A total of 264 strains of fungal blood culture were positive from 2015 to 2017, mainly from the departments of hepatobiliary surgery (81 strains), cardiac surgery (57 strains), emergency (24 strains), thoracic surgery (22 strains), and hematology (16 strains). Candida is the main genus, of which Candida parapsilosis is the most common one, with 142 strains (53.8%), followed by Candida corneum (36 stains, 13.6%), Candida albicans (20 strains, 7.6%) and Candida tropical (18 strains, 6.8%). Taking fungal blood culture as the criterion, we found that the sensitivity, specificity, positive forecast value, and negative forecast value of G test for diagnosis of fungal infection were 61.3%, 87.9%, 31.1%, and 96.2%, respectively. ROC curve analysis showed that G test was valuable for diagnosis of fungal bloodstream infection, with the area under the curve being 0.771 (95% confidence interval: 0.723-0.819). Among 137 cases of bloodstream infection, 102 cases (69.6%) were tested for G test 2-5 d before blood culture, and 71 cases were positive. Conclusion Plasma G test kit is still ideal in terms of specificity and has a certain clinical value for the early diagnosis of fungal bloodstream infection.

Role of recombinant major surface glycoprotein C consensus antigen of Pneumocystis jirovecii in serological diagnosis of Pneumocystis pneumonia / 中国感染与化疗杂志

Objective To evaluate the clinical value of recombinant major surface glycoprotein C(Msg C)consensus antigen of Pneumocystis jirovecii in serological diagnosis of Pneumocystis pneumonia(PCP), and explore serological diagnosis for PCP. Methods ELISA method was established for testing IgM antibody of Pneumocystis jirovecii Msg C consensus antigen. Serum antiMsg C consensus antigen IgM antibody and(1, 3)-β-D glucan were determined in 48 patients at high risk of PCP and 51 healthy subjects. The results of ELISA and(1, 3)-β-D glucan assay were compared with the results of PCR in bronchoalveolar lavage fluid. Results In a total of 99 specimens, Msg C consensus antigen IgM antibody detection(28.3％, 28/99)showed similar positive rate as(1, 3)-β-D glucan assay(25.3％, 25/99)(P>0.05). For the 48 patients at high risk of PCP, the positive rate of Msg C consensus antigen IgM antibody and(1, 3)-β-D glucan assay was 35.4％(17/48)and 33.3％(16/48), respectively(P>0.05). The two methods showed 67.7％ agreement in testing 99 specimens and 52.1％ agreement in testing 48 high-risk specimens. The bronchial lavage fluid samples of 48 patients at high risk were also tested by PCR. The result was positive in 15 cases(31.3％), showing no significant difference from Msg C consensus antigen IgM antibody test(P=0.665). The agreement between Msg C consensus antigen IgM antibody test and PCR was 58.3％. The agreement with PCR result increased to 84.0％ in the 25 specimens with the same result by two serological methods.When taking the positive result of either serological method as reference, serological method can detect majority of the PCR positive cases(86.7％, 13/15). Conclusions IgM antibody against Msg C consensus antigen in combination with serological marker(1, 3)-β-D glucan is valuable for PCP diagnosis. Further examination such as lower respiratory tract specimen PCR and conventional cytology should be carried out to confirm the diagnosis when both IgM antibody against Msg C consensus antigen and(1, 3)-β-D glucan are positive.

Clinical features of candidemia and the diagnostic value of (1, 3) -β-D glucan / 中国感染与化疗杂志

Objective To understand the etiology and clinical characteristics of candidemia, and the diagnostic value of(1, 3)-β-Dglucan. Methods This analysis included 31 patients with candidemia, 39 patients with Candida deep colonization, and 50 healthy subjects, who were enrolled from Wuyi Chinese Hospital Affiliated to Jinan University during the period from September 2015 to March 2018. Clinical data such as fungal culture, clinical features, and serum(1, 3)-β-D-glucan level were analyzed and compared between groups. Results Overall, 13 strains of Candida albicans and 18 strains of non-albicans Candida were isolated from the 31 patients with candidemia. The incidence of candidemia was associated with old age(>65 years), prior surgery(≤7 days), indwelling catheter(≥2 catheters and lasting ≥5 days), duration of mechanical ventilation(≥5 days)(P<0.05), but not associated with sex, underlying disease, prior use of anmicrobial and antifungal agents, immunosuppressant or glucocorticoid, or hypoproteinemia(P>0.05). Serum level of(1, 3)-β-D-glucan was significantly higher in candidemia patients than in the patients with candida deep colonization and healthy controls(P<0.05). The sensitivity and specificity of(1, 3)-β-D-glucan in diagnosing candidemia were 87.1％ and 96.0％, respectively. The level of(1, 3)-β-D-glucan was significantly higher in candidemia with bacterial infection than candidemia without bacterial infection(P<0.05). The level of of(1, 3)-β-D-glucan was also significantly higher in the candidemia caused by Candida albicans alone than that caused by non-albicans Candida alone(P<0.05). Conclusions Non-albicans Candida is more prevalent than Candida albicans in candidiasis, but Candida albicans is still the most important Candida species. The incidence of candidemia is asociated with advanced age(>65 years), prior surgery within 7 days, indwelling catheters(≥2 catheters and lasting ≥5 days), and mechanical ventilation(≥5 days). Serum(1, 3)-β-D-glucan level is valuable for early diagnosis of candidemia.

Detection of LAMP and changes of 1, 3-β-D-glucan in Pneumocystis carinii pneumonia rats / 国际检验医学杂志

Objective To investigate the feasibility of LAMP detection in Pneumocystis carinii pneumonia rats and the changes of 1, 3-β-D-glucan.Methods 40 Wister rats were randomly divided into control group and lung infection group, 20 rats in each group.Specific primers were designed for pneumoniae carinii and LAMP technique was carried out to identify whether the rats were infected or not.The levels of 1, 3-β-D-glucan in peripheral blood and lung lavage fluid were detected by ELISA.Results Compared with the control group, there were 4 dead rats in the lung infection group, the body weight decreased significantly, and the lung weight and the percentage of the lung volume increased significantly (P＜0.05).LAMP method can detect Pneumocystis carinii, the control group was negative.Compared with the control group, the level of 1, 3-β-D-glucan in peripheral blood and lung lavage fluid in the lung infection group increased.And the 1, 3-β-D-glucan level in lung lavage fluid was higher than that in peripheral blood (P＜0.05).Conclusion In this study, we successfully constructed a rat model of Pneumocystis carinii pneumonia and established a simple and rapid method for LAMP detection of Pneumocystis carinii.1, 3-β-D-glucan and Pneumocystis carinii have some relevance.

G-test and GM-test combined with sputum fungal culture for the early diagnosis of invasive fungal infection in intensive care unit patients / 中国感染控制杂志

Objective To evaluate the detection value of serum (1,3)-β-D glucan (G-test) and galactomannan (GM-test) combined with sputum fungal culture in the early diagnosis of invasive fungal infection(IFI) in intensive care unit(ICU) patients.Methods Inpatients with high risk factors for IFI in the ICU of the Affiliated Hospital of Xuzhou Medical University between January 2015 and December 2016 were chosen,they were divided into 3 groups according to the diagnostic criteria of IFI:IFI group(including confirmed and clinically diagnosed cases),suspected IFI group,and non-IFI group.The results of serum G-test,GM-test,and sputum fungal culture in three groups of patients were analyzed,early diagnostic value in IFI with combined three tests was evaluated.Results A total of 264 ICU patients were investigated,IFI group,suspected IFI group,and non-IFI group were 56,43,and 165 cases respectively.Among 56 cases of confirmed IFI,46,39,and 34 were positive for G-test,GM-test,and fungal culture respectively.The sensitivity,specificity,positive predictive value,and negative predictive value of combined three detection were 98.2％,82.4％,65.5％,and 99.3％ respectively,positive likelihood ratio,negative likelihood ratio,and Youden index were 5.58,0.02,and 0.98 respectively.The sensitivity and negative predictive values of combined three detection were both higher than those of single G-test,GM-test,and sputum fungal culture (all P＜0.05);but specificity and positive predictive value of combined three detection were not significantly different from single G-test,GM-test,and sputum fungal culture(all P＞0.05).Conclusion The combination of G-test,GM-tests,and sputum fungal culture can improve the sensitivity of early diagnosis of IFI in ICU patients,and guide the clinicians in the early treatment of IFI.

Application value of lipopolysaccharides and (1-3)-β-D glucan detection in acute pancreatitis complicating infection / 国际检验医学杂志

Objective To investigate the clinical application value of endotoxin and (1-3)-β-D glucan detection in the patients with acute pancreatitis(AP).Methods The MB-80 microbiology rapid dynamic detection system was applied to detect the concentration of plasma LPS and (1-3)-β-D glucan in the patients with AP.Then the results were analyzed.Results Among 184 cases of AP complicating peripancreatic abscess and bilateral lung infection,endotoxin G-lipopolysaccharides positive was in 23 cases,the average value was 394.07 pg/mL,the positive rate was 10.87%,and 15 cases of Gram-negative bacterial infection were verified by the microorganism culture.Among 175 cases of AP complicating peripancreatic abscess and bilateral lung infection,67 cases were(1-3)-β-D glucan positive,the average value was 93.22 pg/mL,the positive rate was 38.29%,which were with the positive rate of serum(1-3)-β-D glucan in the non-AP group,the difference was statistically significant(P<0.05),the microorganism culture or smear verified that 22 cases were fungal infection.Conclusion Plasma endotoxin and (1-3)-β-D glucan detection provides the laboratory biological indicator and is conducive to the assessment of AP infection severity and clinical medication.

Clinical value of serum (1-3 )-β-d-glucan detection on diagnosis of deep fungal infection / 国际检验医学杂志

Objective To investigate the clinical value of serum (1-3)-β-D-glucan(BG) detection (G test) in early diagnosis of deep fungal infection .Methods 132 patients with suspected deep fungal infection in the Chongqing Emergency Medical Center from October 2015 to April 2016 were selected as the research subjects .Among them ,38 cases definitely diagnosed and suspected diagnosed deep fungal infection served as the positive group and other 94 cases were taken as the negative group .Serum BG level was measured by Jinshanchuan MB-80 microbial dynamic detection system ,and the results were compared with the fungal culture results by the body fluid fungal culture .Results The serum BG level of the positive group was (150 .8 ± 133 .2)pg/mL ,and which of the negative group was (25 .7 ± 20 .1)pg/mL ,the difference was statistically significant (t=5 .76 ,P＜0 ,05) .The sensitivity ,specificity ,positive predictive value and negative predictive value of G test were 78 .9% ,85 .1% ,68 .1% and 91 .0% respectively ;the sensitivity ,specificity ,positive predictive value and negative predictive value of fungal culture were 57 .9% ,80 .9% ,52 .3% and 82 .6%respectively .Conclusion The serum BG detection is fast ,accurate ,simple and convenient ,and has clinical application value in the early diagnosis of deep fungal infection and clinical rational medication guidance .

Clinical evaluation of the (1, 3)-β-D-glucan assay as an aid to diagnosis of fungal infections in severe pneumonia patients / 中华急诊医学杂志

Objective To evaluate (1,3)-β-D-glucan (BG) assay as an aid for invasive fungal infection (IFI) diagnosis in severe pneumonia patients (diagnosis followed 2007 American Thoracic Society (ATS) and Infectious Disease Society of America (IDSA) severe pneumonia standard).Methods BG antigenemia was measured by BG Assay Box.IFIs was classified according to the blood fungal laboratory reports.Results 558 patients (185 females,373 males,mean age 64.7) were included.41 patients were proven to be fungal infected to be classified in exposure group.BG assay mean value in exposure group and unexposure group were (568.53 ±796.57) pg/mL,(51.4 ±63.27) pg/mL,respectively.Patients in the exposure group had significantly higher BG assay value than patients in the unexposure group (P ＜0.05).For the cutoff 100 pg/mL recommended by manufacturer,the sensitivity,specificity,positive predict value and negative predict value of the BG assay were 92.7％,92.5％,49.4％ and 0.6％,respectively.Conclusion BG assay has positive clinical value in invasive fungal infection diagnosis in severe pneumonia patients.

Values of G test and GM test combined with fungal culture method for diagnosis of invasive fungal infection in lungs / 军事医学

Objective To evaluate the diagnostic efficiency of deep fungal infection by detecting the serum galactomannan ( GM) and bronchoalveolar lavage fluid ( BALF) GM, serum G test and fungal culture of BALF in patients with suspected invasive fungal infection ( IFI) in lungs.Methods A retrospective analysis was performed of the results of serum /BALF GM test ,serum G test and BALF culture from 148 patients with suspected pulmonary IFI .The indexes involved sensitivity , specificity , positive predictive value , negative predictive value , as well as diagnostic capacity for deep fungal infection with separated or combined tests .Results Among the 148 cases, 48 cases were clinically diagnosed with IFI and the rest were excluded.Among the 48 IFI cases, 3 cases were positive in serum GM test , 25 cases were positive in BALF GM test , 31 cases were positive in G test and 30 cases were positive in fungal culture .The combined detection showed a sensitivity of 91.6%,specificity of 70.0%, positive predictive value of 59.5% and negative predictive value of 94.6%.Conclusion The combination of GM/G tests and fungal culture can significantly improve the clinical diagnostic efficiency of pulmonary IFI .

The performance evaluation of G test on patients with invasive pulmonary fungal infections complicated with chronic obstructive pulmonary disease / 国际检验医学杂志

Objective To evaluate the value of (1 ,3)‐β‐D‐glucan(G test) in the diagnosis of invasive pulmonary fungal infection (IPFI)in patients with chronic obstructive pulmonary disease (COPD) .Methods 96 COPD patients with high risk of IPFI were en‐rolled in the study ,and were divided into IPFI group and non‐IPFI group .The G test were performed on those people while the tra‐ditional methods sputum smear and fungal culture were also performed .The (1 ,3)‐β‐D‐glucan concentrations of IPFI group and non‐IPFI group were compared ,and then the areas under receiver operating characteristic curve (ROC) were calculated .The sensi‐tivity ,specificity ,positive predictive value ,negative predictive value ,and the area under ROC of the two methods (G test and tradi‐tional methods) were compared .Results The sensitivity ,specificity ,positive predictive value ,negative predictive value of G test were 89 .5% ,89 .6% ,68 .0% ,97 .2% ,respectively ,when 20 pg/mL was the critical value .Areas under curve were 0 .942 for G test ,and 0 .790 for traditional method .Conclusion The detection of (1 ,3)‐β‐D‐glucan might be faster and with higher positive rate than traditional method ,and could be used for the early diagnosis of IPFI ,provide reference for the treatment .

Diagnostic value of plasma 1,3-β-D-glucan test in invasive fungal infections / 国际检验医学杂志

Objective To investigate the diagnostic value and optimal threshold value of plasma 1,3-β-D-glucan test (G test)in the invasive fungal infections (IFI).Methods 46 patients diagnosed with IFI in our hospital from February 2012 to March 2014 were enrolled in this study,and 30 patients without IFI underwent surgical elective surgery in our hospital were selected as the neg-ative controls.The plasma 1,3-β-D-glucan content was quantitatively detected by using MB-80 microbial dynamic rapid detection system and its supporting G test kit.The results were evaluated by ROC curve for the determination of the optimal threshold value of G test.Results The plasma 1,3-β-D-glucan levels were (45.28±44.50)pg/mL in the IFI group and (8.62±4.85)pg/mL in the control group respectively,and the difference was statistically significant (P <0.05 ).The results of ROC curve analysis showed that the optimal threshold value of plasma 1 ,3-β-D-glucan used for diagnosis of IFI was 14.7 pg/mL;the area under the curve was up to 0.937;95% CI was between 0.888 and 0.990;the sensitivity and specificity were 88.9% and 90.3% respectively;G test had a better diagnostic efficiency.Conclusion The plasma 1 ,3-β-D-glucan test has a diagnostic application value for IFI,which can be used as the early warning indicator of IFI.

Clinical application of combined detection of three indicators in pulmonary tuberculosis patients accompanied with infection / 国际检验医学杂志

Objective To explore the clinical significance of the three indicators combined detection that plasma endotoxin,pro-calcitonin (PCT)and (1,3)-β-D-glucan(BG)in pulmonary tuberculosis patients complicated with bacterial,fungal infection.Methods Retrospective investigation was conducted in 240 pulmonary tuberculosis patients,who were divided into gram negative bacteria (G- )group(39cases),gram positive bacteria (G+ )group(45 cases)including fungal,germ-free group(156 cases).Other 45 healthy people were selected into control group.The levels of plasma endotoxin,PCT and BG in the four groups were compared.Results The levels of plasma endotoxin(0.682±0.418)EU/mL,PCT(2.93±0.87)μg/L in the G- group were significant higher than those of the G+ group (0.063±0.034)EU/mL,(0.85±0.52)μg/L,the difference was significant (P <0.05).The levels of the plasma endotoxin,PCT in the G- group were higher than those of the germ-free group.The levels of plasma endotoxin,PCT and BG in the control group had no significant difference with those of the germ-free group.Conclusion The combined detection of plasma endo-toxin,PCT and BG have some clinical value on the early diagnosis of the patients with pulmonary tuberculosis complicated with G-fungal infection for the advantages of fast and sensitiveness.

The effect of albumin on (1, 3)-β-D-glucan for diagnosis of invasive fungal infections / 中华危重病急救医学

ObjectiveTo explore the diagnostic value of plasma (1, 3)-β-D-glucan test (G test) in diagnosis of invasive fungal infections (IFI) and the influence of albumin on G test.Methods A prospective observational study was conducted. 267 patients admitted to medical intensive care unit (MICU) of Dalian Municipal Central Hospital from January 21st, 2012 to October 31st, 2014 were enrolled. According to IFI guideline, the patients were divided into without IFI group (n= 35), possible IFI group (n = 70), hypotheticle IFI group (n = 145) and proven IFI group (n = 17). G test was examined routinely using microbiology kinetic rapid reader MB-80.The different threshold values were calculated on G test. The difference among G tests, fungal culture and clinical diagnosis were compared. The results of G test ahead of and post albumin administration in each group were compared, and the value of G test for diagnosis of IFI during albumin infusion was evaluated.Results When the cut-off value was 20 ng/L for IFI diagnosis, higher sensitivity (79.8%), specificity (87.9%), and Youden index (67.7%) were found. The positive rates of G test, fungal culture and clinical diagnosis of IFI were 57.7% (154/267), 60.7% (162/267) and 54.3%(145/267) respectively, without showing significant differences (allP> 0.05). The result of G test (ng/L) was not obviously changed after albumin administration compared with that before in without IFI, possible IFI, hypotheticle IFI, and proven IFI groups (without IFI group: 11.25±2.33 vs. 10.99±1.07,t= -1.723,P= 0.085; possible IFI group: 53.14±5.53 vs. 49.22±8.11,t= -0.395,P= 0.693; hypotheticle IFI group: 90.30±9.38 vs. 85.41±10.11, t= 710.500,P= 0.860; proven IFI group: 100.98±19.24 vs. 103.21±17.66,t= 653.000,P= 0.449). Prior to the administration of albumin, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and Youden index were 79.8%, 87.9%, 45.6%, 96.7%, 67.7%, respectively. However, after the administration of albumin, they were 81.5%, 85.7%, 44.8%, 96.5%, and 67.2%, respectively, without significant difference.Conclusions G test is method for early diagnosis of IFI. The sensitivity and specificity are higher with 20 ng/L as the critical value. The result of G test is not interfered by albumin administration.

Change of (1,3)-β-D-glucan in tear before and after penetrating keratoplasty for fungal keratitis / 中华实验眼科杂志

Background Penetrating keratoplasty (PKP) has become an effective method of treatment for fungal keratitis in recent years,but the application timing of glucocorticoids after PKP is still unclear.Literature reported that the concentration of tear (1,3)-β-D-glucan in fungal keratitis was significantly higher than that in normal.Objective This study was to investigate the change of tear (1,3)-β-D-glucan before and after PKP in fungal keratitis and to explore the application duration of anti-fungal drugs and application timing of glucocorticoids.Methods This study protocol was approved by ethic committee of Affiliated Hospital of Qingdao University.A serial cases-observational study was performed from August,2011 to December,2012.Twenty eyes of 20 patients with fungal keratitis were collected in Affiliated Hospital of Qingdao University.PKP was performed in affected eyes,and the fellow health eyes served as controls.Tear of 50 μl was obtained in the controls on 1 day before operation and 1 day,7,14,21 and 28 days after operation to detect tear (1,3)-β-D-glucan levels.Results Tear (1,3)-β-D-glucan levels were (14.67±3.84)mg/L,(1 861.66±196.17) mg/L,(927.71±155.82)mg/L,(392.30±71.22)mg/L,(179.60±40.47) mg/L,(40.20± 12.46) mg/L and (15.12± 1.80) mg/L in the control group,preoperative 1 day,postoperative 1 day,7,14,21,28 days,respectively,showing a significant difference among various time points (F=883.45,P=0.00).Tear (1,3)-β3-D-glucan levels were gradually reduced with the lapse of the postoperative time,with significant differences between adjacent timepoints (t' =13.84,t =16.67,t' =11.02,t' =13.97,t' =-8.45,all at P=0.00).Tear (1,3)-β-D-glucan levels in postoperative 28 days came near that of normal control group,without significant difference between them (P =0.64).Fungal keratitis recurred in 2 eyes on the fifth and sixth day after operation,with the tear (1,3)-β-D-glucan levels of 2 350.24 mg/L and 1 992.82 mg/L,respectively.Conclusions The concentration of (1,3)-β-D-glucan in the tears increases in the eyes with fungal keratitis and drops to normal range at 28 days after PKP,indicating that the antifungal eyedrops should be applied until 4 weeks after PKP,and this is an optimal timing of using corticosteroid eyedrops to resist reject reaction.

Detection of (1, 3)-β-D-glucan for diagnosis of invasive fungal infection in premature infants / 中国小儿急救医学

Objective To evaluate the diagnostic value of (1,3)-β-D-glucan assay (G test) in the plasma of premature infants with invasive fungal infection(IFI) and determinate the best diagnostic value of G test.Methods The premature infants who were at risk of IFI from NICU were enrolled in Shengjing Hospital of China Medical University from July 2010 to September 2011.The concentration of (1,3)-β-D-glucan were detected by GKT-5MSet microbial dynamic detection system,and the fungal and bacterial culture were performed in the same samples of blood.We used to perform statistic analysis for sensitivity,specificity,positive predictive value and negative predictive value at different cutoff values,and draw receiver operating characteristic curve for G test.Results Forty-four infants were eligible for the study,of 17 permature infants with IFI,and of 27 ones with non IFI,in whom bacterial culture was positive in 12 cases and culture was negative in 15 cases.The concentration of (1,3)-β-D-glucan in IFI group [5 ～ 3 117 pg/ml,median (Q75-25)190.60(501.44) pg/ml] was higher than that in non IFI group[5.0 ～434.3 pg/ml,median(Q75-25) 5.86(5.62) pg/ml],the difference was significant(Z =-3.77,P ＜ 0.01).15 pg/ml was the best cutoff value,and the area under curve was 0.839,95 ％ CI(0.697,0.980).Conclusion G test is useful in the diagnosis of IFI in premature infants with high sensitivity and specificity.G test can be used for the screening of high-risk patients with high risk of fungal infection ratio.

Diagnostic value of plasma(1,3)-beta-D-glucan detection for invasive fungal infection / 国际检验医学杂志

Objective To explore the clinical value of plasma(1,3)-β-D-glucan detection(G test)in the diagnosis of invasive fun-gal infections(IFI).Methods The plasma samples were collected in 67 cases of IFI,61 cases of non-IFI and 48 healthy controls from January to September 2013.The level of(1,3)-D-glucan in plasma was detected by the kinetic turbidimetric assay and the opti-mal critical value of the G test was determined by receiver operating characteristic curve(ROC).Results The levels of(1,3)-β-D glucan in the IFI,non-IFI and healthy control groups showed the non-normal distribution.However,the median level of plasma(1, 3)-β-D glucan in the IFI group was 208.00pg/mL,which was significantly higher than 61.30 pg/mL(Z =-5.083,P <0.01)in the non-IFI group and 31.16 pg/mL(Z =-8.288,P <0.01)in the healthy control group.The area under ROC of the G test for diag-nosing IFI was 0.846 and the optimal critical value was 90.49pg/mL.The corresponding sensitivity,specificity,positive and nega-tive predictive values were 86.6%,77.1%,69.9% and 90.3%,respectively;at the same time,which of the fungal culture for diag-nosing IFI were 53.7%,94.5%,85.7% and 61.9% respectively.Conclusion Plasma(1,3)-β-D-glucan detection exhibits the high sensitivity and the better negative predictive value for the diagnosis of IFI.But the false positive results occur at times.It is sugges-ted that the G test can be dynamically conducted combined with the fungal culture for improving the efficiency of IFI diagnosis.

The diagnosis and monitor for fungal keratitis by detection of (1,3-) β-D-glucan in tears / 中华实验眼科杂志

Background The diagnosis and treatment of fungal keratitis are knotty.There is no quantitative method to identify the disease and judge the therapeutic effect of the antifungal agent.Studies have determined that serum (1,3-) β-D-glucan level can sensitively and specifically reflect the state of systemic mycotic-causing diseases.However,whether (1,3-) β-D-glucan level in tear can monitor and diagnose mycotic keratitis is unclear.Objective Purpose of this study was to investigate the change of tear (1,3-) β-D-glucan level following the administration of antifungal drug in fungal keratitis patients,and evaluate the diagnosis and monitor value of (1,3-) β-D-glucan in tears for fungal keratitis.Methods Sixty patients who were diagnosed as fungal keratitis by fungal culture were analyzed in Affiliated Hospital of Qingdao University Medical College from July 2010 to May 2012.The patients received the topical administration of antifungal drug for 28 days.Thirty healthy volunteers without eye disease served as normal controls.The tear of 50 μl was collected from each subject for the detection of (1,3)-β-D-glucan before the therapy,7,14,28 days after therapy and 7 days,14 days after the drugs were stopped,respectively.The dynamic changes of (1,3-) β-D-glucan levels in tears were evaluated and compared with the manifestation of the lesions under the laser scanning confocal microscope.The patients without hyphal by the laser scanning confocal microscopy and tear (1,3-)β-D-glucan level less than 20 ng/L were subsequently treated for another 7 days,and the following-up duration was 2 months.The informed consent was obtained before any medical examination was performed from each subject.Results (1,3-)β-D-glucan level in tears (Log value) was (6.37 ±0.48)ng/L in the patient group,and was significantly higher than (2.00±0.31) ng/L in the normal control group (t =2.89,P＜0.01).The lesion was smaller with the gradually clear border,and the number of mycelia was decreased under the laser scanning confocal microscope 7 days after treatment.(1,3-) β-D-glucan level in tears was gradually declined in a time-dependent manner after treatment.The (1,3)-β-D-glucan level in tears (Log) was (5.19 ± 0.42),(4.16 ± 0.33),(2.99 ±0.42),(2.91 ±0.39),(2.80±0.40) ng/L 7,14,28 days after treatment,and 7 days,14 days after the drugs were stopped,respectively,with a statistically significant difference in comparison with (6.37±0.48)ng/L before treatment (P＜0.01).(1,3)-β-D-gluean level in tears remained a lower level till the end of follow-up,and no recurrence of lesion was found in the patient group.Conclusions Detecting (1,3)-β-D-glucan level in tears is of good diagnosis and monitor value in the evaluation of fungal keratitis.

Diagnostic value of (1,3)-β-D-glucan assay and galactomannan test for invasive fungal infection in patients of acute radiation sickness / 中华放射医学与防护杂志

Objective To investigate the diagnostic values of (1,3)-β-D-glucan (G) and galactomannan (GM) for invasive fungal infection (IFI) in patients of acute radiation sickness (ARS).Methods Samples of periogeral blood,pharyngeal secretion,urine,and feces were collected from 316patients with ARS and suspected to suffer from IFI,192 males and 124 females,aged 60.50(1-96),with the underlying diseases of blood or respiration systems.Platelia Aspergillus EIA kit was used to detect the plasma BG (G test),and ELISA was used to detect the serum GM (GM test).Fungal culture and bacterial culture were performed.Results The positive rates of G test,GM test,and fungal culture were 36.33%,35.84% ,and 34.18% respectively,but the positive rate of fungal culture of blood sample was 1/316 only.Pearson correlation analysis showed that G test,GM test and fungal culture test were positively correlated with IFI clinical diagnosis respectively (x2 = 0.564,0.357,0.727,P ＜ 0.05).Conclusions Easy to operate,rapid,and highly sencitive,G test and GM test can be used as adjunctive methods for early IFI diagnosis in ARS patients.