Huang Yu-Tsung, Hung Chien-Ching, Liao Chun-Hsing, Sun Hsin-Yun, Chang Shan-Chwen, Chen Yee-Chun
Department of Internal Medicine, National Taiwan University Hospital, No. 7 Chung-Shan South Road, Taipei 100, Taiwan.
J Clin Microbiol. 2007 Sep;45(9):2858-62. doi: 10.1128/JCM.00050-07. Epub 2007 Jun 27.
Galactomannan (GM) is a heteropolysaccharide in the cell walls of most Aspergillus and Penicillium species. Cross-reactivity of Cryptococcus neoformans galactoxylomannan in an Aspergillus GM test has also been reported. In this study, we used a Platelia Aspergillus enzyme immunoassay kit (Bio-Rad) to test serum samples obtained from 48 human immunodeficiency virus (HIV)-infected patients (15 with penicilliosis [7 with fungemia alone, 4 with cavitary lung lesions alone, 3 with both fungemia and cavitary lung lesions, and 1 with disseminated disease], 22 with cryptococcosis [11 with fungemia alone, 5 with cavitary lung lesions, 3 with both, and 3 with meningitis alone], and 11 without any invasive fungal infection [control]) for GM levels. None of the patients had aspergillosis or concurrent use of piperacillin-tazobactam or amoxicillin-clavulanate. The median time between diagnosis of fungal infection and collection of serum samples was 0 days for penicilliosis and 1.5 days for cryptococcosis. Of patients with penicilliosis, cryptococcosis, and controls, 73.3%, 13.6%, and 9%, respectively, had GM optical density (OD) indices of >0.5 (P = 0.0001). GM OD indices were higher for penicilliosis (median OD index, 4.419; range, 0.158 to >20) than for cryptococcosis (median, 0.247; range, 0.112 to 3.849) cases (P < 0.001). Patients with fungemic penicilliosis had higher OD indices (median, 10.628; range, 0.401 to >20) than patients with nonfungemic penicilliosis (median, 0.378; range, 0.158 to 4.419) and patients with cryptococcemia (median, 0.231; range, 0.112 to 1.168) (P < 0.001). Of the 15 patients with cavitary lung lesions, those with penicilliosis had higher antigen levels (median OD index, 1.641; range, 0.247 to >20) than those with cryptococcosis (median, 0.227; range, 0.112 to 3.849) (P = 0.011). This study showed that the GM OD index was significantly elevated for HIV patients with penicilliosis. The use of the GM antigen assay may facilitate earlier diagnosis of Penicillium marneffei infection for HIV-infected patients in areas of endemicity.
半乳甘露聚糖（GM）是大多数曲霉属和青霉属物种细胞壁中的一种杂多糖。也有报道称新型隐球菌半乳甘露聚糖在曲霉GM检测中存在交叉反应性。在本研究中，我们使用普立泰曲霉酶免疫分析试剂盒（伯乐公司）检测了从48例感染人类免疫缺陷病毒（HIV）的患者（15例马尔尼菲青霉病患者[7例仅患有真菌血症，4例仅患有空洞性肺部病变，3例同时患有真菌血症和空洞性肺部病变，1例患有播散性疾病]，22例隐球菌病患者[11例仅患有真菌血症，5例患有空洞性肺部病变，3例同时患有这两种疾病，3例仅患有脑膜炎]，以及11例无任何侵袭性真菌感染的患者[对照组]）获取的血清样本中的GM水平。所有患者均未患有曲霉病，也未同时使用哌拉西林 - 他唑巴坦或阿莫西林 - 克拉维酸。马尔尼菲青霉病患者从真菌感染诊断到血清样本采集的中位时间为0天，隐球菌病患者为1.5天。在马尔尼菲青霉病、隐球菌病患者及对照组中，GM光密度（OD）指数>0.5的患者分别占73.3%、13.6%和9%（P = 0.0001）。马尔尼菲青霉病患者的GM OD指数（中位OD指数为4.419；范围为0.158至>20）高于隐球菌病患者（中位值为0.247；范围为0.112至3.849）（P < 0.001）。患有真菌血症的马尔尼菲青霉病患者的OD指数（中位值为10.628；范围为0.401至>20）高于非真菌血症的马尔尼菲青霉病患者（中位值为0.378；范围为0.158至4.419）以及患有隐球菌血症的患者（中位值为0.231；范围为0.112至1.168）（P < 0.001）。在15例有空洞性肺部病变的患者中，患有马尔尼菲青霉病的患者的抗原水平（中位OD指数为1.641；范围为0.247至>20）高于患有隐球菌病的患者（中位值为0.227；范围为0.112至3.849）（P = 0.011）。本研究表明，马尔尼菲青霉病的HIV患者的GM OD指数显著升高。在流行地区，GM抗原检测的应用可能有助于HIV感染患者更早地诊断马尔尼菲青霉感染。
