epiglucan and Endophthalmitis

To review the literature on beta-D-glucan (BDG) testing in fungal endophthalmitis.. Review of primary literature using PubMed through April 2017 and presentation of an illustrative case report. A total of 231 articles were identified and 43 were ultimately chosen for review based on relevance and presence of ophthalmologic examination and objective data.. Beta-D-glucan is a major component of fungal cell walls. It is quantified using a calorimetry-based Fungitell assay based on modification of the limulus amebocyte lysate. Serum BDG levels are commonly used clinically in conjunction with other tests for early surveillance and diagnosis of invasive fungal infections. In the ophthalmic literature, elevated levels of BDG have been detected in vitreous fluid of patients undergoing vitrectomy for fungal endophthalmitis, tear fluid of patients with mycotic keratitis, and serum of a patient with bilateral endogenous subretinal abscesses. Elevated serum BDG levels appear to be highly associated with fungal endophthalmitis. Potential uses and considerations with regards to test limitations are discussed.. Beta-D-glucan testing may be used as an adjunct to support a diagnosis, initiate pharmacologic therapy or surgical intervention, and optimize overall clinical management in patients diagnosed with or under clinical suspicion for invasive fungal infections, including endophthalmitis. Additional clinical studies are necessary to fully characterize the utility of BDG testing in patients with fungal endophthalmitis.

Topics: beta-Glucans; Biomarkers; Diagnostic Tests, Routine; Endophthalmitis; Eye Infections, Fungal; Female; Humans; Sensitivity and Specificity; Young Adult

To assess the diagnostic utility of (1→3)-β- d -glucan (BDG) in ocular fluid of patients with fungal endophthalmitis.. This prospective pilot single-center study evaluated aqueous and vitreous humor BDG levels of suspected fungal endophthalmitis, bacterial endophthalmitis, and noninfectious controls with the standard Fungitell assay and the Fungitell STAT assay. β- d -Glucan levels were compared using generalized linear models followed by post hoc pairwise comparisons.. Seven fungal endophthalmitis, 6 bacterial endophthalmitis, and 17 noninfectious ocular samples were evaluated. Mean aqueous BDG concentrations were 204, 11.0, and 9.6 pg/mL for fungal endophthalmitis, bacterial endophthalmitis, and noninfectious controls, respectively ( P = 0.01, fungal vs. bacterial; P = 0.0005, fungal vs. noninfectious controls). Mean vitreous BDG concentrations were 165, 30.3, and 5.4 pg/mL, respectively ( P = 0.001 for fungal vs. bacterial; P < 0.0001 for fungal vs. noninfectious controls). Mean vitreous BDG index (Fungitell STAT) values were 1.7, 0.4, and 0.3, respectively ( P = 0.001, fungal vs. bacterial; P = 0.0004, fungal vs. noninfectious controls). The Pearson correlation between BDG levels and BDG index was high (correlation coefficient = 0.99, P < 0.001).. Significantly elevated ocular BDG levels were found in fungal endophthalmitis compared with bacterial endophthalmitis and noninfectious controls. Our study suggests a potential utility for BDG testing in the diagnosis of fungal endophthalmitis, and a larger study is warranted.

Topics: beta-Glucans; Endophthalmitis; Eye Infections, Fungal; Glucans; Humans; Prospective Studies; Sensitivity and Specificity

To evaluate vitreous Galactomannan(GM) and 1,3 β-D-Glucan (BDG) levels in the diagnosis of fungal endophthalmitis, with emphasis on culture-negative cases.. Vitreous from 31 clinically suspected fungal endophthalmitis patients and 11 controls were evaluated for GM and BDG using ELISA Kits. The Receiver Operating Characteristic (ROC) curves and diagnostic significance was calculated.. The median vitreous GM in culture-positive (60.83pg/ml) and culture-negative (59.9pg/ml) samples were higher than the (51.2pg/ml) control group. The median vitreous BDG in culture-positive (1.47pg/ml) and culture-negative (1.52pg/ml) samples were also similar, and higher than the control group (1.18pg/ml). ROC analysis showed that at a cut-off of 51.35pg/ml, the sensitivity and specificity for GM were 0.88 and 0.73.Similarly, for BDG at a cut-off of 1.18pg/ml, the sensitivity and specificity were 0.94 and 0.82 respectively.. Vitreous GM and BDG above the indicated threshold level could suggest a fungal infection, even when cultures are negative.

Topics: beta-Glucans; Endophthalmitis; Eye Infections, Fungal; Glucans; Humans; Mannans; Sensitivity and Specificity

To evaluate the value of the β- d -glucan (BDG) testing of intraocular fluid for the diagnosis of fungal endophthalmitis (FE).. Twenty patients (22 eyes) with FE were diagnosed using both culture and nonculture methods. Intraocular fluid was collected for BDG testing, including 22 eyes of FE and 55 eyes of control group. Under different BDG cutoff points as the test-positives, the BDG sensitivity, specificity, positive predictive value, and negative predictive value for FE were analyzed.. The BDG testing value was 1,022.78 ± 1,362.40 pg/mL in the FE group, significantly higher than that of the control group (105.0 ± 180.80 pg/mL, P < 0.001). The area under the receiver operating characteristic (ROC) curve was 0.885 (95% confidence interval, 0.793-0.978; P < 0.001). With the prespecified BDG cutoff 107.83 pg/ml as the test-positive, sensitivity was 81.8%, specificity was 87.5%, and the Youden index was 0.693. When the BDG cutoff was depicted as 202.05 pg/mL, sensitivity reduced to 77.3%, specificity increased at 95.8%, and the Youden index reached the highest value of 0.731.. β- d -glucan testing of intraocular fluid demonstrated good sensitivity and specificity regarding the diagnosis of FE, which can provide earlier diagnosis to achieve better outcomes.

Topics: Aqueous Humor; beta-Glucans; Endophthalmitis; Eye Infections, Fungal; Glucans; Humans; ROC Curve; Sensitivity and Specificity

To evaluate serum beta-D-glucan (BDG) as a biomarker for endogenous fungal eye infection.. Retrospective case-control study of 88 patients with a BDG test and eye examination at UPenn (2013-2018). Cases had endogenous fungal chorioretinitis or endophthalmitis diagnosed by eye examination and confirmed with positive culture; controls were without these fungal eye findings. Charts were reviewed for BDG values, blood/vitreous cultures, and eye examinations. Outcomes were BDG sensitivity, specificity, positive predictive value, and negative predictive value for fungal chorioretinitis or endophthalmitis, using prespecified BDG cut-off points of ≥80, ≥250, and ≥500 pg/mL as test positive.. Cases included six chorioretinitis and four endophthalmitis patients. Controls included 78 patients without chorioretinitis or endophthalmitis. Defining BDG ≥80 pg/mL as test positive, the BDG sensitivity (95% confidence interval) was 66.7% (22.3%-95.7%) for chorioretinitis and 100% (39.8%-100%) for endophthalmitis. The specificity was 74.4% (63.2%-83.6%) when BDG values ≥80 pg/mL were test positive, and 85.9% (76.2%-92.7%) when values ≥250 pg/mL were test positive. For a 1% endophthalmitis prevalence and BDG cut-off value of ≥80 pg/mL, the positive predictive value was 3.8% (2.4%-5.2%) and negative predictive value was 100% (99.1%-100%).. For endogenous fungal endophthalmitis, BDG's sensitivity and specificity seem good and the negative predictive value is high; a larger ophthalmic study is indicated.

Topics: Adult; beta-Glucans; Biomarkers; Case-Control Studies; Endophthalmitis; Eye Infections, Fungal; Female; Humans; Male; Middle Aged; Predictive Value of Tests; Retrospective Studies; ROC Curve

BACKGROUND In clinical practice, the presentation of fungal endophthalmitis is often occult and confusing, so it is difficult to make an early diagnosis. The aim of this study was to evaluate the utility of ß-d-glucan (BDG) testing in diagnosis, management, and prognosis of fungal endophthalmitis. CASE REPORT We present a retrospective, observational case series of 5 fungal endophthalmitis cases, 3 of which were endogenous and 2 exogenous. There were significantly elevated BDG levels in all cases, which was consistent with the pathological diagnosis. Four cases were diagnosed as fungal endophthalmitis through smear or culture and gene chip analysis of intraocular fluid. CONCLUSIONS Fungal endophthalmitis is rare, and its diagnosis is difficult because of its occult nature. Therefore, BDG testing may be required as an auxiliary examination for the early diagnosis of fungal endophthalmitis. Compared to cultures and smears, intraocular fluid BDG testing has a higher sensitivity for detecting fungal endophthalmitis.

Topics: Adult; Aged; Aqueous Humor; beta-Glucans; Child, Preschool; China; Diagnostic Tests, Routine; Endophthalmitis; Eye Infections, Fungal; Female; Humans; Male; Middle Aged; Retrospective Studies; Sensitivity and Specificity

We report findings for a 74-year-old woman with Candida tropicalis endophthalmitis for whom an increase in b-D-glucan level and worsening of endophthalmitis were observed after intravenous injection of micafungin, an echinocandin antifungal agent. Endogenous endophthalmitis caused by C. tropicalis developed in both eyes. On the basis of her surgical history, laboratory data,and lesions, tentative diagnosis of fungal endophthalmitis was made. She was then treated with fluconazole and itraconazole, but the b-D-glucan level did not decrease, and there was no improvement of the endophthalmitis. The fluconazole was discontinued and replaced by micafungin.Unexpectedly, the level of b-D-glucan increased and endophthalmitis did not improve. The micafungin was immediately stopped and replaced by intravenous fluconazole with amphotericin B syrup, but the itraconazole was continued. Marked resolution of the vitreous inflammation was observed in both eyes, and the serum b-D-glucan level was reduced. Because active macular infiltrates were observed in the right eye, vitrectomy was performed. The micafungin minimum inhibitory concentration against the C. tropicalis strain isolated from our patient was 0.03 lg/ml. This paradoxical effect of micafungin should be remembered, and b-D-glucan level should be frequently monitored after intravenous injection of micafungin.

Topics: Aged; Antifungal Agents; beta-Glucans; Candida tropicalis; Candidiasis; Echinocandins; Endophthalmitis; Female; Fundus Oculi; Humans; Itraconazole; Lipopeptides; Micafungin