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1.
J. Health Biol. Sci. (Online) ; 10(1): 1-6, 01/jan./2022. tab
Article in English | LILACS | ID: biblio-1411461

ABSTRACT

Objectives: The purpose of this study was to evaluate the mutagenic potential of fluoxetine and fluoxetine-galactomannan. Methods: Chromosomal aberration test and Salmonella typhimurium/microsome mutagenicity assay. Results: The results showed that fluoxetine (250 µg/mL) can cause chromosomal breaks of treated leukocytes and increase the frequency of reversion of the tester strains of S. typhimurium / microsome assay only at the highest concentration (5 mg/mL), while fluoxetine encapsulated in galactomannan did not cause these changes (leukocytes and S. typhimuriums strains). Conclusion: In summary, fluoxetine showed a mutagenic effect detectable only at high concentrations in both eukaryotic and prokaryotic models. Furthermore, the fluoxetine/galactomannan complex, in this first moment, prevented the mutagenicity attributed to fluoxetine, emphasizing that the present encapsulation process can be an alternative in preventing these effects in vitro.


Objetivos: avaliar o potencial mutagênico da fluoxetina e da fluoxetina-galactomanana. Métodos: Teste de aberração cromossômica e ensaio de mutagenicidade de Salmonella typhimurium /microssoma. Resultados: a fluoxetina (250 µg/mL) pode causar quebras cromossômicas de leucócitos tratados e aumentar a frequência de reversão das cepas testadoras de S. typhimurium /microssoma apenas na concentração mais alta (5 mg/mL), enquanto a fluoxetina encapsulada em galactomanano não causou essas alterações (leucócitos e cepas de S. typhimurium). Conclusão: a fluoxetina mostrou um efeito mutagênico detectável apenas em altas concentrações em modelos eucarióticos e procarióticos. Além disso, o complexo fluoxetina/galactomanan, neste primeiro momento, evitou a mutagenicidade atribuída à fluoxetina, ressaltando que o presente processo de encapsulamento pode ser uma alternativa na prevenção desses efeitos in vitro.


Subject(s)
Fluoxetine , Chromosome Aberrations , Salmonella typhimurium , Chromosome Breakage , Microsomes , Mutagenicity Tests
2.
Rev. chil. infectol ; 39(3)jun. 2022.
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1407786

ABSTRACT

Resumen Introducción: La prueba Aspergillus galactomannan Ag Virclia® (GM-VClia) es una técnica de galactomanano monotest, auto-matizada, basada en inmunoensayo quimioluminiscente (CLIA). Objetivo: Evaluar el desempeño del test de GM-VClia en muestras de suero y lavado bronquioalveolar (LBA) procesadas previamente con el kit Platelia™ Aspergillus EIA (GM-Plat). Materiales y Métodos: Se estudiaron 56 muestras de suero y 40 de LBA, correspondientes a un total de 59 pacientes (algunos con determinación de galactomamano en ambas muestras) con enfermedades pulmonares, hematológicas, LES, Covid-19 y tumores, entre otros. Trece pacientes tuvieron aspergilosis invasora (1 probada y 12 probables). Resultados: La correlación entre ambos métodos para suero y LBA fue r = 0,8861 p < 0,0001 y r = 0,6368 p < 0,001, respectivamente. Hubo una concordancia global de 67,7% (65/96), siendo de 85,7% (48/56) en sueros y 42,5,0% (14/49) en LBA. Al subir el punto de corte en LBA por GM-VClia la concordancia aumentó a 85,7%. Conclusiones: Se observó una mayor correlación y concordancia en sueros que en LBA. El kit GM-VClia presentó una mayor sensibilidad y valor predictor negativo (VPN), que el kit GM-Plat. Las desventajas de GM-VClia, la constituyen la categoría "dudoso", que dificulta la interpretación y que, con los puntos de corte actuales en LBA, la correlación con GM-Plat es menor. Las ventajas son su mayor sensibilidad, facilidad de procesamiento y una mayor rapidez en los resultados.


Abstract Background: The Aspergillus Galactomannan Ag Virclia® (GMVClia) test is a monotest and automated galactomannan technique based on chemiluminescent immunoassay (CLIA). Aim: To evaluate the performance of the GM-VClia test in serum and bronchioalveolar lavage (BAL) samples previously processed with the Platelia ™ Aspergillus EIA kit (GM-Plat). Methods: 56 samples of serum 40 from BAL (some of them with galactomaman determination in both samples), from patients with pulmonary diseases, hematological diseases, SLE, Covid-19 and tumors, among others, were studied. Thirteen patients had invasive aspergillosis (1 proven and 12 probable). Results: The correlation between both methods for serum and BAL was r = 0.8861 p < 0.0001 and r = 0.6368 p < 0.001, respectively. There was a global concordance of 67.7% (65/96), being 85.7% (48/56) in sera and 42.5.0% (14/49) in BAL. By raising the cut-off point in LBA by GM-VClia, the agreement increased to 85.7%. Conclusion: A greater correlation and concordance was observed in sera than in BAL. The GM-VClia kit had a higher sensitivity and NPV than the GM-Plat kit. The disadvantages of GM-VClia are the "doubtful" category, which makes interpretation difficult and that with the current cut-off points in LBA the correlation with GM-Plat is lower. The advantages are its greater sensitivity, ease of processing and faster results.

3.
Article in Chinese | WPRIM | ID: wpr-934061

ABSTRACT

Objective:To investigate the clinical diagnostic value of combined detection of serum and bronchoalveolar lavage fluid (BALF) galactomannan (GM) for invasive pulmonary aspergillosis (IPA) in children with non-neutropenia.Methods:An analysis was made on 100 children with non-neutropenia suspected of invasive pulmonary aspergillosis in the respiratory ward of the Children′s Hospital Affiliated to Capital Institute of Pediatrics from January 2019 to March 2020. All of them were tested by serum and BALF GM tests as well as sputum and BALF culture for fungi. The sensitivity, specificity and accuracy of serum and BALF GM in the diagnosis of IPA in non-neutropenic children were analyzed. The receiver operating characteristic (ROC) curve and the area under the ROC curve (AUC) were used to evaluate the clinical diagnostic value of serum and BALF GM tests for IPA in children with non-neutropenia.Results:The recruited 100 cases included one confirmed case, 85 clinically diagnosed cases and two suspected cases, while the 12 cases were excluded. The accuracy and 95% confidence interval (95%CI) of serum and BALF GM tests used alone and in combination in the clinical diagnosis of IPA in non-neutropenic children were 29.0% (95%CI: 20.1%-37.9%), 75.0% (95%CI: 66.5%-83.5%) and 81.0% (95%CI: 73.3%-88.7%), respectively. The AUC and 95%CI were 0.645 (95%CI: 0.513-0.778), 0.785 (95%CI: 0.644-0.926) and 0.819 (95%CI: 0.681-0.953), respectively.Conclusions:The combined detection of serum and BALF GM was better than a single indicator in the clinical diagnosis of IPA in non-neutropenic children, suggesting the combined detection was of great value in clinical diagnosis.

4.
Rev. chil. infectol ; 38(6): 754-760, dic. 2021. ilus, tab
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1388316

ABSTRACT

INTRODUCCIÓN: Se han descrito coinfecciones fúngicas por Aspergillus spp. en pacientes críticos cursando una infección por COVID-19. OBJETIVOS: Describir las características clínicas, diagnóstico, tratamiento y evolución de pacientes con síndrome de distrés respiratorio agudo con COVID-19, que cursan con aspergilosis pulmonar asociada a COVID-19 (CAPA por sus siglas en inglés) en un centro hospitalario público. Pacientes y MÉTODOS: Revisión de registros clínicos durante 12 meses en pacientes con diagnóstico de CAPA mediante cultivos de muestras respiratorias o determinación de galactomanano (GM). RESULTADOS: En 11 pacientes se diagnosticó CAPA probable (score APACHE II promedio de 11,7). Las muestras respiratorias se obtuvieron en 73% de los casos por lavado broncoalveolar y en 27% por aspirado endotraqueal. Se aisló A. fumigatus en 4 cultivos, A. niger, A. terreus y Aspergillus spp en una ocasión cada uno y los cultivos fueron negativos en 4 muestras. En 7 pacientes se realizó GM de muestras respiratorias, mediana: 3,6 (RIC: 1,71 - 4,4), en 10 pacientes se realizó GM sérica, mediana: 0,5 (RIC: 0,265 - 0,975) con 50% de ellas > 0,5. Dos pacientes mostraron hallazgos sugerentes de CAPA en la tomografía computada. Todos recibieron terapia anti-fúngica con voriconazol, con una duración promedio 14 días. Cuatro pacientes fallecieron. CONCLUSIONES: La presencia de CAPA debe ser un diagnóstico a considerar en pacientes críticos con COVID-19.


BACKGROUND: Aspergillus spp. fungal coinfections have been described in critically ill COVID-19 patients. AIM: To describe the clinical characteristics, diagnosis, treatment and evolution of patients with acute respiratory distress syndrome with COVID-19, who present with COVID-19 associated pulmonary aspergillosis (CAPA) in a single public hospital. METHODS: Retrospective review of clinical records during 12 months in patients diagnosed with CAPA by cultures of respiratory samples or determination of galactomannan (GM). RESULTS: Probable CAPA was diagnosed in 11 patients (average APACHE II score of 11.7). Respiratory samples were obtained in 73% of cases by bronchoalveolar lavage and in 27% by tracheal aspirate. A. fumigatus was isolated in 4 cultures, A. niger, A. terreus and Aspergillus spp on one occasion each and the cultures were negative in 4 samples. Respiratory sample GM was performed in 7 patients, median: 3.6 (IQR: 1.71 - 4.4). In 10 patients, serum GM was performed, median: 0.5 (IQR: 0.265 - 0.9 75) with 50% of them > 0.5. Two patients showed classic findings suggestive of CAPA on computed tomography. All received antifungal therapy with voriconazole, mean time 14 days. Four patients died. CONCLUSIONS: The presence of CAPA should be a diagnosis to be considered in critically ill COVID-19 patients.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Pulmonary Aspergillosis/complications , Pulmonary Aspergillosis/diagnosis , Pulmonary Aspergillosis/drug therapy , Invasive Pulmonary Aspergillosis/complications , Invasive Pulmonary Aspergillosis/diagnosis , Invasive Pulmonary Aspergillosis/drug therapy , COVID-19/complications , Aspergillus , Chile/epidemiology , Critical Illness , SARS-CoV-2 , Hospitals, Public
5.
Electron J Biotechnol ; 49: 64-71, Jan. 2021. ilus, tab, graf
Article in English | LILACS | ID: biblio-1291923

ABSTRACT

BACKGROUND: Manno-oligosaccharides (MOS) is known as a kind of prebiotics. Mannanase plays a key role for the degradation of mannan to produce MOS. In this study, the mannanases of glycoside hydrolase (GH) families 5 Man5HJ14 and GH26 ManAJB13 were employed to prepare MOS from locust bean gum (LBG) and palm kernel cake (PKC). The prebiotic activity and utilization of MOS were assessed in vitro using the probiotic Lactobacillus plantarum strain. RESULTS: Galactomannan from LBG was converted to MOS ranging in size from mannose up to mannoheptose by Man5HJ14 and ManAJB13. Mannoheptose was got from the hydrolysates produced by Man5HJ14, which mannohexaose was obtained from LBG hydrolyzed by ManAJB13. However, the same components of MOS ranging in size from mannose up to mannotetrose were observed between PKC hydrolyzed by the mannanases mentioned above. MOS stability was not affected by high-temperature and high-pressure condition at their natural pH. Based on in vitro growth study, all MOS from LBG and PKC was effective in promoting the growth of L. plantarum CICC 24202, with the strain preferring to use mannose to mannotriose, rather than above mannotetrose. CONCLUSIONS: The effect of mannanases and mannan difference on MOS composition was studied. All of MOS hydrolysates showed the stability in adversity condition and prebiotic activity of L. plantarum, which would have potential application in the biotechnological applications.


Subject(s)
Oligosaccharides/metabolism , beta-Mannosidase/metabolism , Plant Gums/chemistry , Mannans , In Vitro Techniques , Enzyme Stability , Sphingomonas , Prebiotics , Fermentation
6.
Braz. j. biol ; 79(2): 169-173, Apr.-June 2019. tab, graf
Article in English | LILACS | ID: biblio-989440

ABSTRACT

Abstract Even today, an effective diagnostic test for aspergillosis in penguins is unknown, being the gold standard post-mortem examinations. The fungal antigen galactomannan (GM) has been used as a biomarker of disease in humans and is detected by the Platelia Aspergillus EIA (BioRad)®, a commercial kit based on the sandwich ELISA technique. It is standardized for use in neutropenic patients, however studies have demonstrated its usefulness also possible for birds. The aim of our study was to evaluate the effectiveness of Platelia Aspergillus EIA® test (BioRad-US) in the diagnosis of aspergillosis in Magellanic penguins, determining sensitivity, specificity, and positive and negative predictive values for different cut-off points. Were included in the study, blood serum samples (n = 29) Magellanic penguins in captivity that died by aspergillosis. Detection of GM was performed following manufacturer's instructions and the GM index was obtained by dividing the average value of OD of the duplicate of the clinical sample by duplicate OD of the average value of the cut-off sample provided by the kit. Through information database results were obtained for the presence of anti-Aspergillus fumigatus antibodies detected by agar gel immunodiffusion (AGID) for all serum samples. Results were analyzed using chi-square test and Kruskal-Wallis from SPSS 20.0, IBM®. ROC curve was obtained and from this, rates of sensitivity, specificity, positive and negative predictive values were also calculated based on four different cutoff points (0.5, 1.0, 1.5 and 2.0). The serum GM index did not differ between animals of the case and control group (pkw =0.097). In determining the ROC curve for serum GM detection the value of area under the curve was 0.635. From the values ​​determined by the coordinate of the curve, four different cut points (0.5, 1.0, 1.5 and 2.0) were analyzed, resulting in sensitivity rates ranging from 86.2 to 34.5% % and specificity between 87% and 26.1%. By comparing the serum GM index in group case as the presence or absence of antibodies detected by AGID was found p=0.503. The detection of GM the Platelia Aspergillus EIA® test seems is not be useful for the diagnosis of aspergillosis in naturally infected penguins.


Resumo Ainda hoje, um teste diagnóstico eficaz para aspergilose em pinguins não é conhecido, sendo o padrão-ouro os exames post-mortem. O antígeno fúngico galactomanana (GM) tem sido utilizado como biomarcador da doença em humanos, sendo detectado pelo Platelia Aspergillus EIA (BioRad)®, um kit comercial que se baseia na técnica ELISA sanduíche. É padronizado para utilização em pacientes neutropênicos, no entanto estudos tem demonstrado sua possível utilidade também para aves.O objetivo de nosso estudo foi avaliar a eficácia do teste Platelia Aspergillus EIA® (BioRad-US) no diagnóstico da aspergilose em pinguins-de-Magalhães, determinando sensibilidade, especificidade e valores preditivos positivos e negativos em diferentes pontos de corte. Foram incluídas no estudo, amostras de soro sanguíneo (n=29) de pinguins-de-Magalhães em cativeiro que vieram a óbito por aspergilose. A detecção de GM foi realizada seguindo instruções do fabricante e o índice de GM foi obtido dividindo o valor da média da DO da duplicata da amostra clínica pelo valor da média da DO da duplicata da amostra de cut-off fornecida pelo kit. Através de informações em banco de dados foram obtidos resultados sobre a presença de anticorpos anti-Aspergillus fumigatus, detectada por Imunodifusão em gel de ágar (IDGA) em todas as amostras séricas. Os resultados foram analisados utilizando-se teste de qui-quadrado e Kruskal-Wallis a partir do programa estatístico SPSS 20.0, IBM®. Curva ROC foi obtida e a partir desta, taxas de sensibilidade, especificidade, valores preditivo positivo e negativo foram igualmente calculados considerando quatro diferentes pontos de corte (0.5, 1.0, 1.5 e 2.0). O índice de GM sérica não diferiu entre os animais do grupo caso e controle (pKW = 0.097). Na determinação da curva ROC para detecção de GM sérica o valor da área sobre a curva foi de 0.635. A partir dos valores determinados pelas coordenadas da curva, quatro diferentes pontos de corte (0.5, 1.0, 1.5 e 2.0) foram analisados, resultando em taxas de sensibilidade variando de 86.2% a 34.5%, e de especificidade entre 87% e 26.1%. Ao comparar o índice de GM sérica nos animais do grupo caso quanto a presença ou não de anticorpos detectados pela IDGA foi encontrado p=0.503. A detecção de GM pelo teste Platelia Aspergillus EIA® não parece ser útil para o diagnóstico da aspergilose em pinguins naturalmente infectados.


Subject(s)
Animals , Aspergillosis/diagnosis , Aspergillosis/veterinary , Aspergillus/isolation & purification , Enzyme-Linked Immunosorbent Assay/methods , Spheniscidae/microbiology , Biomarkers/analysis , Mannans/analysis
7.
Article in Chinese | WPRIM | ID: wpr-815981

ABSTRACT

OBJECTIVE: To explore the diagnostic value of serum Aspergillus IgG antibody combined with BALF galactoman(GM) in the diagnosis of pulmonary aspergillosis and provide a new scheme for clinical diagnosis of aspergillus infection. METHODS: 97 patients suspected of pulmonary aspergillus infection were selected in our hospital during March 2016 and September 2017. Serum IgG and BALF GM were performed for all, ROC curve analysis was used to compare the diagnostic value. RESULTS: 58 cases diagnosed as pulmonary aspergillosis and 39 non-aspergillus infection patients were enrolled in this study as patient group and control group, respectively. Serum IgG antibody level in patient group is significant higher than control group(P<0.05), and also higher in chronic pulmonary aspergillosis(CPA) patients, compared with invasive pulmonary aspergillosis(IPA) patients. The sensitivity and specificity were 53.4%, 94.9% respectively if the cut-off value of serum IgG test was set as 140 IU/ml. When the cut-off value of BALF GM test was 0.5, the sensitivity and specificity were 75.9%, 76.9%. The ROC curve area of serum IgG antibody, BALF GM was 0.770, 0.813, respectively. When combined serum IgG antibody and BALF GM together, the area under the curve was 0.897. Conclution The combined serum IgG antibody and BALF GM tests improved the diagnostic value of pulmonary aspergillosis, it is recommended to clinical diagnosis.

8.
Chinese Critical Care Medicine ; (12): 331-335, 2019.
Article in Chinese | WPRIM | ID: wpr-753964

ABSTRACT

Objective To evaluate the accuracy and diagnostic value of bronchoalveolar lavage fluid galactomannan test (BALF-GM) combined with serum GM test on invasive pulmonary aspergillosis (IPA). Methods 190 cases of BALF-GM and 4 787 cases of serum GM specimens suspected of fungal infection in patients admitted to Affiliated Hospital of Jining Medical University from January 2016 to June 2018 were enrolled and analyzed. All patients were classified into clinically confirmed IPA, clinically diagnosed IPA, suspected IPA and excluded IPA according to the classification standard of Expert consensus on diagnosis and treatment of pulmonary mycosis. The coincidence rate of BALF and serum GM test results with clinical diagnosis was analyzed. Receiver operating characteristic (ROC) curve was performed, and the diagnostic value of BALF and serum GM test alone or in combination for IPA was evaluated. Subgroup analysis was performed in patients with normal or abnormal immune function, and the sensitivity and specificity of BALF and serum GM test were compared separately or jointly. Results The positive rate of BALF-GM was 46.8% (89/190), and 10.4% (497/4 787) on serum GM. Among them, 156 patients were both tested on BALF and serum GM. There were 44 cases with both positive in BALF and serum GM, the coincidence rate of clinical definite was 93.2% (41/44). There were 34 cases with positive BALF-GM and negative GM test in serum, and the coincidence rate of clinical definite was 64.7% (22/34). There were 56 cases positive in serum GM and negative in BALF-GM, and the coincidence rate of clinical definite was 48.2% (27/56). BALF and serum GM tests were both negative in 22 cases, and the coincidence rate of exclusion diagnosis was 90.9% (20/22). ROC curve analysis showed that the diagnostic value of BALF-GM test combined with serum GM test for IPA was better than that of BALF-GM test or serum GM test alone [area under ROC curve (AUC): 0.992 vs. 0.983, 0.976]. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 95.3%, 87.0%, 93.2% and 90.9%, respectively. Subgroup analysis showed that among 89 patients with positive BALF-GM test, 85 cases (95.5%) had normal immune function and 4 cases (4.5%) had unknown condition. Among 497 patients with positive serum GM test, 12 cases (2.4%) had normal immune function, 372 cases (74.9%) had abnormal immune function and 113 cases (22.7%) were uncertain. It was shown by ROC curve analysis that the sensitivity of positive BALF-GM test in diagnosis of IPA in patients with normal immune function was higher than that of positive serum GM test (95.6% vs. 88.9%), while the sensitivity of positive serum GM test in patients with abnormal immune function was higher than that of positive BALF-GM test (91.8% vs. 89.9%). Conclusion The results of BALF and serum GM tests are in good agreement with clinical diagnosis, and the combined detection of BALF and serum GM is more valuable for IPA diagnosis than single detection, especially for patients with unknown immune function.

9.
Rev. chil. enferm. respir ; 35(3): 191-198, 2019. tab, graf
Article in Spanish | LILACS | ID: biblio-1058074

ABSTRACT

La aspergilosis pulmonar invasora (API) es una infección causada por hongos del género Aspergillus que afecta principalmente a pacientes inmunocomprometidos y corresponde a la forma más grave de aspergilosis. Se asocia a una alta morbi-mortalidad, siendo fundamental un diagnóstico y tratamiento oportuno. Las manifestaciones clínicas son inespecíficas, por lo que un estudio adecuado es importante para el diagnóstico, principalmente en pacientes con factores de riesgo poco habituales. En la actualidad se han establecido categorías diagnósticas que consideran factores del hospedero, laboratorio micológico tradicional y biomarcadores como galactomanano. Éstos, junto a la mejor comprensión e interpretación de las imágenes tomográficas permiten ofrecer un manejo adecuado. En este artículo, se presentan dos casos clínicos de API en pacientes reumatológicos, y se discute la utilidad de los métodos diagnósticos.


Invasive pulmonary aspergillosis (IPA) is an infection caused by fungi of the genus Aspergillus that mainly affects immunocompromised patients and corresponds to the most severe form of aspergillosis. It is associated with high morbidity and mortality, and diagnosis and timely treatment are essential. Clinical manifestations are nonspecific, so an adequate study is important for diagnosis, mainly in patients with unusual risk factors. At present, diagnostic categories have been established that consider factors of the host, traditional mycological laboratory and biomarkers such as galactomannan. These, together with the better understanding and interpretation of the tomographic images, allow us to offer an adequate management. In this article, two clinical cases of API in rheumatological patients are presented, and the usefulness of the diagnostic methods is discussed.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Rheumatic Diseases/complications , Invasive Pulmonary Aspergillosis/complications , Invasive Pulmonary Aspergillosis/diagnosis , Biomarkers/analysis , Tomography, X-Ray Computed , Immunocompromised Host , Invasive Pulmonary Aspergillosis/drug therapy , Voriconazole/therapeutic use , Mannans/analysis , Antifungal Agents/therapeutic use
10.
Indian J Med Microbiol ; 2018 Dec; 36(4): 557-563
Article | IMSEAR | ID: sea-198817

ABSTRACT

Purpose: Due to limitations of traditional microbiological techniques, standardised fungal biomarker tests such as Galactomannan Index (GMI) and 1,3-beta-D-glucan (BDG) are being preferred for diagnosis of invasive fungal infections (IFIs). These tests have been extensively used in developed countries but seldom in developing countries. The present study was performed to evaluate these tests for the diagnosis of IFIs in immunocompromised patients at an Indian tertiary care centre. Materials and Methods: A retrospective hospital-based study was done in immunocompromised patients with clinical suspicion of IFI. The demographic, clinical, radiological and mycological details of the patients were recorded. The patients were categorised into proven, probable and no IFI (as per European Organization for Research and Treatment of Cancer/Mycoses Study Group criteria). The sensitivity and specificity of BDG Fungitell and Platelia Aspergillus antigen assays was estimated. Results: A total of 70 consecutive patients were included, of which 41 had IFI (10 proven and 31 probable) while 29 had no IFI. A significant association was found between IFI and the presence of a central venous line (P = 0.035) and history of intake of T-cell immunosuppressants (P = 0.001). Median BDG values (pg/ml) in patients with proven IFI, probable IFI and no IFI were 300 (range: 70�0), 165 (range: 53�0) and 45 (range: 31�0), respectively. The receiver operating characteristic (ROC) curve analysis for BDG revealed an area under the curve of 0.995, sensitivity: 97.4% and specificity: 96.6% for IFI diagnosis. The ROC curve analysis of GMI revealed an AUC of 0.75 and 90% patients with invasive aspergillosis (IA) had positive GMI. Conclusion: BDG has good sensitivity and specificity for distinguishing IFI from no IFIs and GMI may be used for diagnosing IA.

11.
Rev. Soc. Bras. Med. Trop ; 51(3): 387-389, Apr.-June 2018. tab, graf
Article in English | LILACS | ID: biblio-1041461

ABSTRACT

Abstract INTRODUCTION: Several factors can cause false-positive results in the galactomannan (GM) test; however, others remain unknown. Presently, the impact of airborne contamination by Aspergillus conidia during enzyme-linked immunosorbent assay (ELISA) remains uninvestigated. METHODS: We studied 12 A. fumigatus isolates. Fungal conidia were serially diluted and tested for GM detection using the Platelia® Aspergillus enzyme immunoassay (EIA). RESULTS: The conidia concentration required for an EIA-positive result was 4.8 × 103 (median). CONCLUSIONS: This is the first study to evaluate the impact of environmental contamination on the Platelia® Aspergillus EIA assay. Only massive contamination can interfere with GM optical readings, suggesting that environmental contamination does not cause false-positive test results.


Subject(s)
Humans , Aspergillus fumigatus/isolation & purification , Spores, Fungal , Enzyme-Linked Immunosorbent Assay/adverse effects , False Positive Reactions , Mannans , Enzyme-Linked Immunosorbent Assay/methods
12.
Indian J Med Microbiol ; 2018 Mar; 36(1): 61-64
Article | IMSEAR | ID: sea-198723

ABSTRACT

Purpose of Study: The western and North-Western parts of India are usually considered non-endemic for histoplasmosis. On the contrary, we observe histoplasmosis cases with relatively higher frequency from this region although the awareness and laboratory facility to diagnose the disease are not adequate. Hence, we planned the present retrospective study to compile the cases and to analyse different clinical parameters. Materials and Methods: Medical records of the patients diagnosed with histoplasmosis during January 2012–August 2017 at two infectious disease clinics of Ahmedabad were included in this study. Results: During the study, 12 cases of histoplasmosis were diagnosed. The median age of the patients was 53 years; all males except one. The diagnosis of histoplasmosis was confirmed on histopathology for 11 cases, and one patient was diagnosed as probable histoplasmosis. The patients were either from Gujarat or Rajasthan without any travel history to endemic zone of histoplasmosis, except one patient. The majority (67%) of the patients had no apparent immunosuppression. Adrenal enlargement, oral ulcers and lymphadenopathy were common presentations in four patients each. We lost two patients in follow-up, and rest 10 patients responded to either to amphotericin B deoxycholate and/or itraconazole therapy. Conclusion: This study highlights that Gujarat and Rajasthan are an endemic region for histoplasmosis, and a systematic study is required to understand epidemiology of the disease. Histoplasmosis should be a differential diagnosis in a patient presenting with adrenal enlargement, lymphadenopathy, oral ulcers and fever of unknown origin in this region.

13.
Rev. chil. infectol ; 35(5): 531-544, 2018. tab, graf
Article in Spanish | LILACS | ID: biblio-978067

ABSTRACT

Resumen La enfermedad fúngica invasora producida por Aspergillus spp., es la infección por hongos filamentosos más frecuentemente reportada en individuos inmunocomprometidos y responsable de una muy alta mortalidad en este grupo de pacientes. En los últimos años se han logrado importantes avances, tanto en su diagnóstico como terapéuticos. Al momento actual se ha identificado una serie de factores de riesgo asociados a su desarrollo, permitiendo la categorización de pacientes en condición de alto, intermedio y bajo riesgo de aspergilosis invasora (AI); y también se han establecido criterios diagnósticos que consideran factores del hospedero, laboratorio micológico tradicional, biomarcadores como galactomanano y 1→3-β-d-glucano, junto a la mejor comprensión e interpretación de las imágenes tomográficas que han permitido consensuar las categorías diagnósticas. Esto, sumado a la incorporación de nuevos antifúngicos y estrategias terapéuticas en diferentes escenarios, ha permitido lograr una disminución de la mortalidad asociada. En este artículo se realiza una puesta al día de los aspectos epidemiológicos, los factores de riesgo, el diagnóstico, la prevención y profilaxis además del enfrentamiento terapéutico, incluyendo las estrategias de uso de terapia antifúngica empírica, precoz y dirigida, así como los aspectos más relevantes de los antifúngicos de primera elección y alternativos para el manejo actualizado de AI.


The invasive fungal disease produced by Aspergillus spp., is the infection by filamentous fungi most frequently reported among immunocompromised individuals and responsible for a very high mortality in this group of patients. In recent years, important advances have been made both from the diagnostic and therapeutic point of view. At present, a series of risk factors associated with its development have been identified, allowing the categorization of patients in high, intermediate and low risk of invasive aspergillosis (IA); and diagnostic criteria have also been established that consider factors of the host, traditional mycological laboratory, biomarkers such as galactomannan and 1→3-β-d-glucan, together with the better understanding and interpretation of the tomographic images that have allowed to reach a consensus on the diagnostic categories. This added to the incorporation of new antifungals and therapeutic strategies in different scenarios, have allowed decreasing the associated mortality. In this review, are updated the epidemiological aspects, the risk factors, the diagnosis, prevention and prophylaxis as well as the therapeutic confrontation, including strategies for the use of empirical, precocious and directed antifungal therapy, as well as the most relevant aspects of the first-choice and alternative antifungals for the IA management.


Subject(s)
Humans , Adult , Aspergillosis/diagnosis , Aspergillosis/drug therapy , Antifungal Agents/therapeutic use , Risk Factors
14.
Article in Chinese | WPRIM | ID: wpr-701558

ABSTRACT

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.

15.
Article in Chinese | WPRIM | ID: wpr-701557

ABSTRACT

Objective To evaluate the effect of galactomannan(GM) test combined with CD4+ T lymphocyte detection on early diagnosis of invasive aspergillosis (IA) in patients with acquired immunodeficiency syndrome (AIDS).Methods 197 AIDS patients who were suspected with IA in a hospital from January 2014 to December 2016 were analyzed retrospectively,they were divided into confirmed IA group (n =35),clinically diagnosed IA group (n=96,suspected cases),and non-IA group(n =66),sensitivity and specificity of GM test and GM test combined CD4+ T lymphocyte counting for diagnosing IA were compared.Results In confirmed IA group,clinically diagnosed IA group,and non-IA group,the medium values of GM (minimum,maximum) were 1.29(0.65,1.84)pg /mL,0.91(0.36,1.23)pg /mL,and 0.11(0.28,0.72)pg /mL respectively,CD4+ T lymphocyte counting were 45 (29,69)cells/μL,79(35,99) cells/μL,and 89 (59,158) cells/μL respectively,GM value and CD4+ T lymphocyte counting among three groups were significantly different(all P<0.05).The sensitivity and specificity of single GM test for diagnosing IA in AIDS patients were 64.9% and 72.7% respectively;sensitivity and specificity of two consecutive GM test within one week for diagnosing IA were 72.5 % and 95.5 % respectively;sensitivity and specificity of GM test combined CD4+ T lymphocyte counting were 86.3% and 90.9% respectively.Conclusion GM test has better diagnostic value for IA in AIDS patients,continuous GM test and GM test combined CD4+ T lymphocyte counting will further improve the clinical diagnostic value for IA.

16.
Article in Chinese | WPRIM | ID: wpr-706939

ABSTRACT

Objective To assess the clinical diagnostic value of sputum fungal culture combined with serum galactomannan (GM) antigen detection in patients with invasive pulmonary aspergillosis (IPA). Methods A total of 567 cases, because of respiratory symptoms and/or suspected aspergillosis infection, admitted into the Affiliated Hospital of Jining Medical University from January to December 2016 were enrolled, the positive rate of pulmonary aspergillosis infection was determined by sputum culture and serum GM test, the values of single sputum culture and the combination of the culture and GM test for diagnosis of IPA were analyzed, and the differences in the positive rates of pulmonary aspergillus determined by GM test and traditional methods [chest computed tomography (CT), sputum culture and blood culture] were compared. At the same time, when fever patients had treated for 3-4 days, the results were ineffective, antifungal therapy was applied according to the disease condition and the results of auxiliary examinations (chest CT, sputum culture and GM test), and the effect of antifungal therapy was observed. Results The serum GM test was positive in 85 cases, and sputum fungal culture was positive in 226 cases, there were 108 cases presenting positive and 148 cases negative in both culture and GM test; the diagnosis of IFD was confirmed in 186 cases (32.8%), clinical diagnosis was made in 107 (18.9%) cases, suspected in 131 (23.1%) cases and excluded in 143 cases (25.2%). Compared with single sputum fungal culture, the sensitivity [98.2% (108/110) vs. 20.4% (46/226)], specificity [85.1% (148/174) vs. 45.1% (148/328)], positive predictive value [80.6% (108/134) vs. 37.1% (46/124)] and negative predictive value [98.1% (148/151) vs. 63.0% (148/235)] of combination method of GM test and sputum fungal culture for diagnosis of IPA were obviously higher; the positive rate of GM test for the detection of pulmonary aspergillus infection was significantly higher than that of traditional methods of chest CT, sputum culture and blood culture [64.7% (55/85) vs. 35.7% (35/98), 20.4% (46/226), 4.8% (14/292)], and the GM value being 0.5 as the positive critical value for the diagnosis of IPA can provide desirable sensitivity and specificity. In this study, 186 patients with pulmonary aspergillus infection had completed the antifungal treatment. The effective rates of antifungal treatment 1, 2, 3 and 6 months after treatment were not significantly changed with the prolongation of the therapeutic time [75.4% (135/179), 77.1% (111/144), 77.2% (31/79), 82.6% (19/23)], but the contents of serum GM was significantly lowered compared with that before treatment [absorbance (A) value: 0.49±0.03, 0.46±0.03, 0.39±0.03, 0.23±0.03 vs. 0.56±0.03, all P < 0.05], the number of positive cases was also decreased (186, 179, 144, 79, 23 respectively), so dynamic GM tests can help observe the therapeutic effect. Conclusion The study results showed: serum GM antigen detection combined with sputum fungal culture can significantly improve the clinical diagnostic efficiency for patients with pulmonary aspergillus infection.

17.
Journal of Medical Postgraduates ; (12): 380-383, 2017.
Article in Chinese | WPRIM | ID: wpr-512338

ABSTRACT

Objective The purpose of this study was to investigate the value of serum galactomannan (GM) in the diagnosis of invasive pulmonary aspergillosis (IPA) in patients with chronic obstructive pulmonary disease (COPD).Methods We enrolled 60 COPD patients in the study, including 19 IPA and 41 non-IPA cases.We examined serum GM of the patients by ELISA, evaluate the value of serum GM test for the diagnosis of IPA in patients with COPD, and compared the GM values before and after treatment.Results With 0.5 as the positive cutoff value, the sensitivity, specificity, positive predictive value, and negative predictive value of serum GM were 57.9%, 95.3%, 84.6%, and 83.0%, respectively, with a high specificity and a low sensitivity.The 7 IPA cases showed a significantly decreased GM value after treatment as compared with the baseline (0.30±0.21 vs 1.48±1.37, P=0.004).Conclusion The serum GM test has a limited value in the diagnosis of IPA in patients with COPD, but dynamic monitoring of the changes of the serum GM value may help evaluate the patient's condition.

18.
Blood Research ; : 300-306, 2017.
Article in English | WPRIM | ID: wpr-21827

ABSTRACT

BACKGROUND: We evaluated the outcomes of serum galactomannan (GM) assay for the screening of invasive pulmonary aspergillosis (IPA) in allogeneic hematopoietic stem cell transplantation (alloHSCT) recipients while on primary antifungal prophylaxis (PAP). METHODS: This study included patients with hematologic disorders who underwent alloHSCT from January 2013 to November 2015. Patients received routine PAP with fluconazole before 2014 and micafungin after 2014; serum GM tests were performed and retrospectively analyzed. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of serum GM tests for detection of probable/proven IPA were evaluated. The serial change of serum GM levels was illustrated on a time series plot. RESULTS: A total of 136 alloHSCT recipients at Seoul National University Hospital were included in the study. Fluconazole was administered in 72 patients for PAP, while micafungin was administered in the remaining 64 patients. The overall sensitivity, specificity, and NPV of serum GM assays were 95.8% (95% confidence interval [CI] 78.9–99.9%), 93.8% (95% CI 91.7–95.5%), and 99.8% (95% CI 99.1–100.0%), respectively. However, the PPV of GM tests was relatively low at 35.4% (95% CI 23.9–48.2%). The serial change in serum GM levels differed according to the antifungal agents used. With effective PAP using micafungin, serial serum GM levels showed zero order kinetics during the neutropenic period. CONCLUSION: Although the serum GM assay is a sensitive and specific test for detecting IPA in alloHSCT recipients, its role for routine surveillance in an era of effective PAP with micafungin is limited.


Subject(s)
Antifungal Agents , Fluconazole , Hematology , Hematopoietic Stem Cell Transplantation , Humans , Invasive Pulmonary Aspergillosis , Kinetics , Mass Screening , Retrospective Studies , Sensitivity and Specificity , Seoul , Stem Cell Transplantation , Stem Cells
19.
Article in Chinese | WPRIM | ID: wpr-619217

ABSTRACT

Objective To evaluate the early diagnostic value of 1,3-β-D glucan(BG) and galactomannan(GM) test for invasive fungal infections(IFI)in intensive care unit(ICU) patients.Methods From 2013 to 2015,the concentration of serum BG and GM were detected in 452 cases of ICU patients,including 182 cases with diagnosis of IFI,46 cases with possible diagnosis of IFI and 224 cases of non-IFI.The diagnostic performance of BG,GM and combined test were analyzed.Results The sensitivity,specificity,positive predictive value(PPV) and negative predictive value(NPV)of BG test were 75.0%,80.4%,75.8%,79.6%.Those of GM test were 25.80%,85.7%,59.5% and 58.7%.The sensitivity and specificity of BG and GM combined test were 87.4% and 94.7% respectively.Conclusion BG and GM combined test could improve the diagnostic efficiency,reduce the false positive rate and false negative rete,which might be helpful for the early diagnosis of IFI in ICU patients.

20.
Bol. micol. (Valparaiso En linea) ; 31(1): 36-41, jun. 2016. ilus
Article in Spanish | LILACS | ID: biblio-868809

ABSTRACT

Se reporta un caso clínico de un paciente masculino de 65 años, que ingresó al hospital por cuadro de 10 días de evolución, con sospecha clí- nica y de laboratorio de un síndrome mieloproliferativo. Estudiado por hematología, se confirmó Leucemia Mieloide Aguda M5. Se inició quimioterapia de inducción. El paciente evolucionó con pancitopenia, destacando neutropenia severa hasta 200 /mm3, febril y sin foco precisado. Se trató con antibióticos de amplio espectro por 10 días con buena respuesta. Cinco días después de finalizar su tratamiento antibiótico, nuevamente comenzó con fiebre, alza de parámetros inflamatorios, neutropenia severa y clínica de foco respiratorio. Se realizó Tomografía Computada (TC) de tórax y galactomanano en sangre, ambos compatibles con aspergilosis pulmonar, por lo que se inició tratamiento con voriconazol. El paciente evolucionó con buena respuesta clínica y de laboratorio, mejoría de imá- genes del TC de tórax y negativización de galactomanano. Al mes cedió la pancitopenia. Fue dado de alta en buenas condiciones generales, con indicación de volver a hospitalizar para quimioterapia de consolidación.


A report of a clinical case of a male patient aged 65 is presented. He entered to the hospital for 10 days evolution box with clinical and laboratory suspicion of a myeloproliferative syndrome. Studied by hematology, acute myeloid leukemia M5 was confirmed. induction chemotherapy began. The patient developed pancytopenia, highlighting severe neutropenia up to 200 / mm3, fever and without pointed focus. He was treated with broadspectrum antibiotics for 10 days with good response. Five days after finishing his antibiotic treatment began with fever again, rising inflammatory parameters, neutropenia and severe respiratory clinical focus. Computed Tomography (CT) of the chest and blood galactomannan was realized, both were compatible with pulmonary aspergillosis, starting treatment with voriconazole. The patient developed good both clinical and laboratory, improvement in chest CT images and negativization galactomannan response. Month later yielded pancytopenia. He was discharged in good general condition, indicating again been hospitalized for consolidation chemotherapy.


Subject(s)
Humans , Male , Aged , Aspergillus/pathogenicity , Invasive Pulmonary Aspergillosis/diagnostic imaging , Invasive Pulmonary Aspergillosis/etiology , Invasive Pulmonary Aspergillosis/blood , Invasive Pulmonary Aspergillosis/drug therapy , Leukemia, Myeloid, Acute/complications , Leukemia, Monocytic, Acute/complications , Neutropenia , Tomography, X-Ray Computed/methods
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