Çuhadar Tuğba, Kalkancı Ayşe, Tunçcan Güzel Özlem, Yeğin Zeynep Arzu, Özkurt Zübeyde Nur, Köktürk Nurdan, Yağcı Münci
Gazi University Faculty of Medicine, Department of Medical Microbiology, Ankara, Türkiye.
Gazi University Faculty of Medicine, Department of Infectious Diseases, Ankara, Türkiye.
Mikrobiyol Bul. 2023 Apr;57(2):274-282. doi: 10.5578/mb.20239921.
Opportunistic fungal infections are an important cause of morbidity and mortality in immunocompromised patients. Invasive aspergillosis (IA) has an important place among these infections with ~ 250.000 cases annually. Reducing the mortality rate due to invasive aspergillosis is possible with early diagnosis and treatment of the disease. Because of the low sensitivity in microscopic examination, the time consuming of culture growth, and the difficulties in distinguishing colonization/infection, serological methods are frequently used in the diagnosis of invasive aspergillosis. The aim of this study was to determine the diagnostic performance of galactomannan and beta glucan tests for the diagnosis of invasive pulmonary aspergillosis (IPA). Sixty patients, followed up with the suspicion of invasive pulmonary aspergillosis in Gazi University Hospital were included in the study. The clinical classification of the patients was made according to the revised European Organization for Research and Treatment of Cancer and the Mycoses Study Group (EORTC/MSG) criteria. A total of 10 patients were classified as probable invasive aspergillosis and 20 patients were classified as possible invasive fungal disease. Demographic data of the patients and various risk factors were recorded. One hundred and thirty serum and nine bronchoalveolar lavage (BAL) fluid samples were studied with Plateliaᵀᴹ Aspergillus Ag (Bio-Rad, France), Dynamiker Aspergillus Galactomannan and Dynamiker Fungus (1-3)-beta-D-Glucan (Dynamiker, China) kits. Sensitivity and specificity values were calculated according to U.S. Food and Drug Administration (FDA) approved Plateliaᵀᴹ Aspergillus Ag test. According to this study, the most important risk factors in the development of IPA were the use of steroids and immunomodulatory drugs. The sensitivity of the galactomannan test in the probable group was 77.8%, the specificity was 96.7%, the sensitivity of the beta glucan test was 61.1%, and the specificity was 92.6%. When these two tests were evaluated together, it was observed that the sensitivity in the probable group increased to 83.3% and the specificity decreased to 89.3%. The combined use of galactomannan and beta glucan tests increases the diagnostic sensitivity. Although the presence of prolonged neutropenia is an important risk factor for IA, the use of steroids and immunomodulatory drugs should be kept in mind in non-neutropenic patients.
机会性真菌感染是免疫功能低下患者发病和死亡的重要原因。侵袭性曲霉病（IA）在这些感染中占有重要地位，每年约有25万例。早期诊断和治疗侵袭性曲霉病可降低其死亡率。由于显微镜检查敏感性低、培养生长耗时以及区分定植/感染存在困难，血清学方法常用于侵袭性曲霉病的诊断。本研究的目的是确定半乳甘露聚糖和β-葡聚糖检测对侵袭性肺曲霉病（IPA）的诊断性能。加齐大学医院60例疑似侵袭性肺曲霉病的患者纳入本研究。根据修订后的欧洲癌症研究与治疗组织和真菌病研究组（EORTC/MSG）标准对患者进行临床分类。共有10例患者被分类为可能的侵袭性曲霉病，20例患者被分类为可能的侵袭性真菌病。记录患者的人口统计学数据和各种危险因素。用Plateliaᵀᴹ曲霉抗原（法国伯乐公司）、Dynamiker曲霉半乳甘露聚糖和Dynamiker真菌（1-3）-β-D-葡聚糖（中国Dynamiker公司）试剂盒检测130份血清和9份支气管肺泡灌洗（BAL）液样本。根据美国食品药品监督管理局（FDA）批准的Plateliaᵀᴹ曲霉抗原检测计算敏感性和特异性值。根据本研究，IPA发生的最重要危险因素是使用类固醇和免疫调节药物。半乳甘露聚糖检测在可能组中的敏感性为77.8%，特异性为96.7%，β-葡聚糖检测的敏感性为61.1%，特异性为92.6%。当将这两种检测一起评估时，观察到可能组中的敏感性增加到83.3%，特异性降低到89.3%。半乳甘露聚糖和β-葡聚糖检测联合使用可提高诊断敏感性。虽然长期中性粒细胞减少的存在是IA的重要危险因素，但在非中性粒细胞减少患者中应牢记类固醇和免疫调节药物的使用。
