epiglucan and arabitol

The biomarkers galactomannan and 1,3-β-d-glucan have been well studied over the past years and are gaining a role in the diagnosis of invasive fungal infections. Although not as well studied until recently, molecular methods for the diagnosis of invasive fungal infection are also being evaluated. Outcomes data for molecular testing are expanding, but have not yet provided enough evidence for inclusion of molecular diagnostics in formal clinical guidelines. Lack of standardization and validation of the various molecular assays and platforms has hindered their widespread acceptance in the evaluation of invasive fungal infections, although the future is promising.

Topics: Aspergillosis; beta-Glucans; Biomarkers; Bronchoalveolar Lavage Fluid; Candidiasis; False Positive Reactions; Galactose; Humans; Mannans; Pathology, Molecular; Polymerase Chain Reaction; Predictive Value of Tests; Sugar Alcohols

Invasive fungal infections have emerged as important causes of morbidity and mortality in neutropenicand some other immunocompromised hosts; Candida and Aspergillus are among the major pathogens in this patient population. The clinical diagnosis of these infections is not specific and the traditional mycological methods for them not sensitive, with limits in the early detection of the pathogen. The potential additives or complements to the laboratory diagnosis of invasive candidiasis and aspergillosis are two non-culture-based methods, serodiagnostic methods and molecular ones. The former methods include the detection of pathogen-specific antigens, antibodies, metabolites and cell wall components. Several have already become standard laboratory tools and some others are under active investigation for developing new, more accurate detection systems. In this review, I will discuss the current status and future potential of serodiagnostic methods, highlighting both their technical and clinical implications.

Topics: Animals; Antibodies, Fungal; Antibody Specificity; Antigens, Fungal; Aspergillosis; Aspergillus; beta-Glucans; Biomarkers; Candida; Candidiasis; Cell Wall; Glucans; Humans; Mannans; Mannitol; Serologic Tests; Sugar Alcohols

We prospectively evaluated a combination of fungal biomarkers in adult haematology patients with focus on their clinical utility at different time points during the course of infection. In total, 135 patients were monitored once to twice weekly for serum (1-3)-ß-d-glucan (BG), galactomannan (GM), bis-methyl-gliotoxin and urinary d-arabinitol/l-arabinitol ratio. In all, 13 cases with proven or probable invasive fungal disease (IFD) were identified. The sensitivity of BG and GM at the time of diagnosis (TOD) was low, but within 2 weeks from the TOD the sensitivity of BG was 92%. BG >800 pg/mL was highly specific for IFD. At a pre-test probability of 12%, both BG and GM had negative predictive values (NPV) >0.9 but low positive predictive values (PPV). In a subgroup analysis of patients with clinically suspected IFD (pre-test probability of 35%), the NPV was lower, but the PPV for BG was 0.86 at cut-off 160 pg/mL. Among IFD patients, 91% had patterns of consecutively positive and increasing BG levels. Bis-methyl-gliotoxin was undetectable in 15 patients with proven, probable and possible IA. To conclude, BG was the superior fungal marker for IFD diagnosis. Quantification above the limit of detection and graphical evaluation of the pattern of dynamics are warranted in the interpretation of BG results.

Topics: Adolescent; Adult; Aged; beta-Glucans; Biomarkers; Diagnostic Tests, Routine; Female; Galactose; Gliotoxin; Hematologic Diseases; Humans; Invasive Fungal Infections; Male; Mannans; Middle Aged; Prospective Studies; Proteoglycans; Sensitivity and Specificity; Serum; Sugar Alcohols; Urinalysis; Young Adult

Topics: Antigens, Fungal; beta-Glucans; Biomarkers; Colorimetry; Humans; Immunity, Cellular; Immunocompromised Host; Mycoses; Nephelometry and Turbidimetry; Opportunistic Infections; Reference Values; Specimen Handling; Sugar Alcohols

Clinical applications and in vitro studies show that all antimycotics are most effective against infection when applied as early as possible. An early diagnosis is, therefore, essential. At this time for aspergillosis and particularly candidosis, a statement is only possible by combining several diagnostic methods. Inflammatory parameters like procalcitonin, C-reactive protein and proinflammatory cytokines are most important evidence of infection. Antigen tests are more significant by higher sensitivity. Attention should be focused on the detection of mannan by ELISA test, beta-glucan and D-arabinitol. Given the present research level in the field of proteomics, the diagnostic importance of transmembranal receptor proteins or other regulatory proteins seems promising.

Topics: Antifungal Agents; Antigens, Fungal; beta-Glucans; C-Reactive Protein; Calcitonin; Cytokines; Early Diagnosis; Mannans; Mycoses; Protein Precursors; Sugar Alcohols