Armed Forces Institute of Pathology (AFIP), National University of Medical Sciences, Rawalpindi, Pakistan.
National Institute of Health (NIH), Islamabad, Pakistan.
J Pak Med Assoc. 2020 Mar;70(3):442-446. doi: 10.5455/JPMA.1476.
To assess the utility of galactomannan and beta-D-glucan assays in the diagnosis of invasive aspergillosis in clinically suspected cases, and to compare their diagnostic potential to determine whether a combination of the two may result in an early and specific diagnosis.
The descriptive cross-sectional case-control study was conducted at the Armed Forces Institute of Pathology, Rawalpindi, Pakistan, from April 1, 2017, to March 31, 2018, and comprised serum samples from clinically suspected invasive aspergillosis patients and healthy controls. The sera were tested for galactomannan and beta-D-glucan detection. Proven, probable and possible categories of invasive aspergillosis according to European Organisation for Research and Treatment of Cancer / Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group criteria. Galactomannan antigen was detected using a one-stage immunoenzymatic sandwich microplate assay. Beta-D-Glucan antigen was detected using a protease zymogen-based colorimetric assay. Sensitivity and positive / negative likelihood ratio of both the cases and the controls were calculated and compared.
Of the 178 subjects, 119(67%) were cases and 59(33%) were controls. Beta-D-glucan assay was more sensitive than galactomannan assay (91.6% versus 80.67%) whereas galactomannan assay was more specific than beta-D-glucan assay (86.44% versus 76.27%) in the diagnosis of invasive aspergillosis. The sensitivities of both assays decreased with decreasing probability of invasive aspergillosis, i.e., maximum sensitivities of both beta-D-glucan and galactomannan assays were for proven cases (100% versus 87.5%), followed by probable cases (89.29% versus 85.71%), and possible cases (91.57% versus 78.31%).
Both beta-D-glucan and galactomannan assays seemed to play an encouraging role in the diagnosis of invasive aspergillosis in high-risk clinically suspected cases, with the former assay being more sensitive and the latter assay being more specific.
评估半乳甘露聚糖和β-D-葡聚糖检测在疑似侵袭性曲霉病患者中的诊断作用，并比较两者的诊断潜能，以确定联合应用这两种检测方法是否可以实现早期、特异性诊断。
本描述性横断面病例对照研究于 2017 年 4 月 1 日至 2018 年 3 月 31 日在巴基斯坦拉瓦尔品第的武装部队病理学研究所进行，纳入疑似侵袭性曲霉病患者和健康对照的血清样本。对血清进行半乳甘露聚糖和β-D-葡聚糖检测。根据欧洲癌症研究与治疗组织/侵袭性真菌感染合作组和美国国家变态反应与传染病研究所真菌病研究组标准，将侵袭性曲霉病分为确诊、拟诊和可能病例。使用一步法免疫酶夹心微孔板检测法检测半乳甘露聚糖抗原，使用基于蛋白酶原的比色法检测β-D-葡聚糖抗原。计算病例和对照组的敏感性和阳性/阴性似然比，并进行比较。
在 178 例患者中，119 例（67%）为病例，59 例（33%）为对照。β-D-葡聚糖检测法的敏感性高于半乳甘露聚糖检测法（91.6%对 80.67%），而半乳甘露聚糖检测法的特异性高于β-D-葡聚糖检测法（86.44%对 76.27%）。两种检测方法的敏感性随侵袭性曲霉病可能性的降低而降低，即两种β-D-葡聚糖和半乳甘露聚糖检测方法的最大敏感性均见于确诊病例（100%对 87.5%），其次是拟诊病例（89.29%对 85.71%）和可能病例（91.57%对 78.31%）。
β-D-葡聚糖和半乳甘露聚糖检测法似乎在高危疑似病例的侵袭性曲霉病诊断中发挥了令人鼓舞的作用，前者的检测法更敏感，后者的检测法更特异。
