Diagnostic Accuracy of Beta-D-Glucan and Galactomannan as Fungal Markers in the Detection of Positive Fungal Cultures among Immunocompromised Patients
Beta-D-Glucan and Galactomannan as Fungal Markers for Positive Fungal Cultures
DOI:
https://doi.org/10.54393/pjhs.v5i09.2224Keywords:
Invasive Fungal Infections, Beta-D-Glucan, Galactomannan, Immunocompromised PatientsAbstract
As fungal infections pose a significant threat to immunocompromised patients, necessitating timely and accurate diagnostic approaches for effective management, non-invasive diagnostic markers are direly needed to detect the presence of fungi during the early stage of the infection. Objectives: To determine the diagnostic accuracy of Beta-D-Glucan and Galactomannan as fungal markers in the detection of positive fungal cultures among immunocompromised patients. Methods: This cross-sectional study was conducted at the Intensive Care Units of Shifa International Hospital, Islamabad, from April 2024 to July 2024. 57 immunocompromised patients of both genders with an age range of 12 to 80 years, who had positive fungal cultures were included in the study via Non-probability, consecutive sampling while patients who were taking any antifungal medications were excluded. Diagnostic accuracy, sensitivity and specificity of Beta-D-Glucan and Galactomannan were calculated by comparing these assay results against the gold standard of CSF analysis of fungal culture. Results: The Beta-D-Glucan and Galactomannan assays showed a specificity of a moderate nature for both assays, slightly higher for Beta-D-Glucan (77.78%) than Galactomannan (72.73%), with a high sensitivity of 92.31% for Beta-D-Glucan and 90.20% for Galactomannan. Overall, the diagnostic accuracy was high for both assays, with Beta-D-Glucan at 96.49% and Galactomannan at 94.74%. conclusions: It was concluded that while the Beta-D-Glucan assay is more sensitive, the Galactomannan assay appears to be more specific. Thus the combined use of both tests enhances diagnostic accuracy for detecting fungal infections in immunocompromised patients.
References
Burghi G, Lemiale V, Azoulay E. Invasive Aspergillosis in Critically ill Hematology Patients: Outcomes and Prognostic Factors Associated with Mortality. Critical Care. 2011 Jan; 15(Suppl 1): P242. doi: 10.1186/cc9662. DOI: https://doi.org/10.1186/cc9662
Pagano L, Stamouli M, Tumbarello M, Verga L, Candoni A, Cattaneo C et al. Risk of Invasive Fungal Infection in Patients Affected by Acute Promyelocytic Leukaemia. A Report by The SEIFEM‐D Registry. British Journal of Haematology. 2015 Aug; 170(3): 434-9. doi: 10.1111/bjh.13308. DOI: https://doi.org/10.1111/bjh.13308
Hammond SP, Marty FM, Bryar JM, DeAngelo DJ, Baden LR. Invasive Fungal Disease in Patients Treated for Newly Diagnosed Acute Leukemia. American Journal of Hematology. 2010 Sep; 85(9): 695-9. doi: 10.1002/ajh.21776. DOI: https://doi.org/10.1002/ajh.21776
Falagas ME and Tassios PT. Enhanced and Earlier Detection of Bacteremia and Fungemia by Multiplex Polymerase Chain Reaction: How Much Enhanced, How Much Earlier, and at What Cost? Critical Care Medicine. 2008 May; 36(5): 1660-1. doi: 10.1097/CCM.0b013e31817045e5. DOI: https://doi.org/10.1097/CCM.0b013e31817045e5
Herbrecht R, Bories P, Moulin JC, Ledoux MP, Letscher‐Bru V. Risk Stratification for Invasive Aspergillosis in Immunocompromised Patients. Annals of the New York Academy of sciences. 2012 Dec; 1272(1): 23-30. doi: 10.1111/j.1749-6632.2012.06829.x. DOI: https://doi.org/10.1111/j.1749-6632.2012.06829.x
Bhaskaran A, Kabbani D, Singer LG, Prochnow T, Bhimji A, Rotstein C et al. (1, 3) β-D-Glucan in Bronchoalveolar Lavage of Lung Transplant Recipients for the Diagnosis of Invasive Pulmonary Aspergillosis. Medical Mycology. 2017 Feb; 55(2): 173-9. doi: 10.1093/mmy/myw052. DOI: https://doi.org/10.1093/mmy/myw052
Mitchell TG. Fundamental Medical Mycology. Emerging Infectious Diseases. 2012 Aug; 18(8): 1393. doi: 10.3201/eid1808.120521. DOI: https://doi.org/10.3201/eid1808.120521
Pfeiffer CD, Fine JP, Safdar N. Diagnosis of Invasive Aspergillosis Using a Galactomannan Assay: A Meta-Analysis. Clinical Infectious Diseases. 2006 May; 42(10): 1417-727. doi: 10.1086/503427. DOI: https://doi.org/10.1086/503427
Acosta J, Catalan M, del Palacio-Peréz-Medel A, Lora D, Montejo JC, Cuetara MS et al. A Prospective Comparison of Galactomannan in Bronchoalveolar Lavage Fluid for the Diagnosis of Pulmonary Invasive Aspergillosis in Medical Patients Under Intensive Care: Comparison with the Diagnostic Performance of Galactomannan and of (1→ 3)–Β–D-Glucan Chromogenic Assay in Serum Samples. Clinical Microbiology and Infection. 2011 Jul; 17(7): 1053-60. doi: 10.1111/j.1469-0691.2010.03357.x. DOI: https://doi.org/10.1111/j.1469-0691.2010.03357.x
Mohr JF, Sims C, Paetznick V, Rodriguez J, Finkelman MA, Rex JH et al. Prospective Survey of (1→ 3)-Β-D-Glucan and Its Relationship to Invasive Candidiasis in the Surgical Intensive Care Unit Setting. Journal of Clinical Microbiology. 2011 Jan; 49(1): 58-61. doi: 10.1128/JCM.01240-10. DOI: https://doi.org/10.1128/JCM.01240-10
Patterson TF and Donnelly JP. New Concepts in Diagnostics for Invasive Mycoses: Non-Culture-Based Methodologies. Journal of Fungi. 2019 Jan; 5(1): 9. doi: 10.3390/jof5010009. DOI: https://doi.org/10.3390/jof5010009
Vazquez R, Vazquez‐Guillamet MC, Suarez J, Mooney J, Montoya JG, Dhillon GS. Invasive Mold Infections in Lung and Heart‐Lung Transplant Recipients: Stanford University Experience. Transplant Infectious Disease. 2015 Apr; 17(2): 259-66. doi: 10.1111/tid.12362. DOI: https://doi.org/10.1111/tid.12362
Ostrosky-Zeichner L, Alexander BD, Kett DH, Vazquez J, Pappas PG, Saeki F et al. Multicenter Clinical Evaluation of the (1→ 3) Β-D-Glucan Assay as an Aid to Diagnosis of Fungal Infections in Humans. Clinical Infectious Diseases. 2005 Sep; 41(5): 654-9. doi: 10.1086/432470. DOI: https://doi.org/10.1086/432470
Pazos C, Pontón J, Palacio AD. Contribution of (1→ 3)-β-D-glucan Chromogenic Assay to Diagnosis and Therapeutic Monitoring of Invasive Aspergillosis in Neutropenic Adult Patients: A Comparison with Serial Screening for Circulating Galactomannan. Journal of Clinical Microbiology. 2005 Jan; 43(1): 299-305. doi: 10.1128/JCM.43.1.299-305.2005. DOI: https://doi.org/10.1128/JCM.43.1.299-305.2005
Obayashi T, Negishi K, Suzuki T, Funata N. Reappraisal of the Serum (1→ 3)-Β-D-Glucan Assay for the Diagnosis of Invasive Fungal Infections—A Study Based on Autopsy Cases from 6 Years. Clinical Infectious Diseases. 2008 Jun; 46(12): 1864-70. doi: 10.1086/588295. DOI: https://doi.org/10.1086/588295
Sims CR, Jaijakul S, Mohr J, Rodriguez J, Finkelman M, Ostrosky-Zeichner L. Correlation of Clinical Outcomes with Β-Glucan Levels in Patients with Invasive Candidiasis. Journal of Clinical Microbiology. 2012 Jun; 50(6): 2104-6. doi: 10.1128/JCM.00773-12. DOI: https://doi.org/10.1128/JCM.00773-12
Cornillet A, Camus C, Nimubona S, Gandemer V, Tattevin P, Belleguic C et al. Comparison of Epidemiological, Clinical, and Biological Features of Invasive Aspergillosis in Neutropenic and Nonneutropenic Patients: A 6-Year Survey. Clinical Infectious Diseases. 2006 Sep; 43(5): 577-84. doi: 10.1086/505870. DOI: https://doi.org/10.1086/505870
Foy PC, Van Burik JA, Weisdorf DJ. Galactomannan Antigen Enzyme-Linked Immunosorbent Assay for Diagnosis of Invasive Aspergillosis After Hematopoietic Stem Cell Transplantation. Biology of Blood and Marrow Transplantation. 2007 Apr; 13(4): 440-3. doi: 10.1016/j.bbmt.2006.11.014. DOI: https://doi.org/10.1016/j.bbmt.2006.11.014
Chang SW, Nam JS, Ha JG, Kim NW, Almarzouq WF, Kim CH et al. Detecting Serum Galactomannan to Diagnose Acute Invasive Aspergillus Sinusitis: A Meta-Analysis. European Archives of Oto-Rhino-Laryngology. 2022 Feb; 279(2): 793-800. doi: 10.1007/s00405-021-06857-8. DOI: https://doi.org/10.1007/s00405-021-06857-8
Fisher CE, Stevens AM, Leisenring W, Pergam SA, Boeckh M, Hohl TM. Independent Contribution of Bronchoalveolar Lavage and Serum Galactomannan in the Diagnosis of Invasive Pulmonary Aspergillosis. Transplant Infectious Disease. 2014 Jun; 16(3): 505-10. doi: 10.1111/tid.12211. DOI: https://doi.org/10.1111/tid.12211
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Pakistan Journal of Health Sciences (Lahore)
This work is licensed under a Creative Commons Attribution 4.0 International License.
This is an open-access journal and all the published articles / items are distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. For comments