epiglucan and Postoperative-Complications

Topics: Aged; beta-Glucans; Biomarkers; Biopsy; Dermatomycoses; Humans; Leg Ulcer; Lung Transplantation; Male; Opportunistic Infections; Postoperative Complications; Pyoderma Gangrenosum; Scedosporium; Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization

Pneumocystis jirovecii is the only fungus of its kind to be pathogenic in humans. It is primarily responsible for pneumonia (PJP). The key to understanding immune defences has focused on T-cells, mainly because of the HIV infection epidemic. Patients presenting with PJP all have a CD4 count below 200/mm(3). The introduction of systematic primary prophylaxis and the use of new anti-retroviral drugs have significantly reduced the incidence of this disease in the HIV-infected population, mainly in developed countries. The increasingly frequent use of corticosteroids, chemotherapy, and other immunosuppressive drugs has led to an outbreak of PJP in patients not infected by HIV. These patients presenting with PJP have more rapid and severe symptoms, sometimes atypical, leading to delay the initiation of a specific anti-infective therapy, sometimes a cause of death. However, the contribution of new diagnostic tools and a better understanding of patients at risk should improve their survival.

Topics: Adrenal Cortex Hormones; Antineoplastic Agents; beta-Glucans; Connective Tissue Diseases; Drug Therapy, Combination; Early Diagnosis; HIV Seronegativity; Humans; Immunocompromised Host; Immunologic Deficiency Syndromes; Immunologic Factors; Immunosuppressive Agents; Neoplasms; Organ Transplantation; Pneumocystis carinii; Pneumocystis Infections; Pneumonia, Pneumocystis; Polymerase Chain Reaction; Postoperative Complications; Prognosis; Radiography; Trimethoprim, Sulfamethoxazole Drug Combination

Invasive deep mycoses following bone marrow and solid-organ transplantation remain a major cause of morbidity and mortality. Species of Candida and Aspergillus account for more than 80% of these mycoses. Because these infections are often difficult to diagnose and treat successfully, antifungal prophylaxis is recommended in high-risk patients. Fluconazole is useful in patients who are at risk of invasive candidiasis, including bone marrow transplants, liver and pancreatic transplants. Although invasive aspergillosis is frequent in patients with bone marrow, lung and heart transplantation, no established methods have been available for its prophylaxis. Recently, efforts to improve the efficiency of diagnostic tests have been directed toward the detection of fungal components or metabolites. The requirements for clinical use (monitoring) are as follows: capability of early diagnosis, quantitative measurement, and easy sampling and simple assay procedure. The detection of plasma (1-3)-beta-D-glucan (BDG), a characteristic cell wall component of almost all fungi, is widely used in Japan. Twenty-seven episodes of fungemia were observed in our hematology ward and all were positive with BDG. Positive results were observed before the documentation of fungemia in 14 patients (51.9%). Although the positive rate of BDG also was 100% in 17 patients with invasive aspergillosis, it rose slightly at an early stage of the disease in 13 patients (76.5%). The determination of plasma BDG appears useful in the monitoring of deep fungal infection, but its usefulness for early diagnosis remains to be determined. The utility of detection of Aspergillus galactomannan by ELISA and fungal DNA by polymerase chain reaction are also discussed.

Topics: Animals; Antifungal Agents; Antigens, Fungal; beta-Glucans; Biomarkers; Galactose; Glucans; Humans; Mannans; Monitoring, Physiologic; Mycoses; Organ Transplantation; Polymerase Chain Reaction; Postoperative Complications

The utility of Aspergillus galactomannan (GM) and β-D-glucan (BG) in liver transplant recipients remains uncertain.. As part of a randomized, double-blind trial of antifungal prophylaxis in liver transplant recipients at risk for invasive fungal infections (IFIs), GM and BG were assessed in 199 patients at baseline (enrollment) and weekly thereafter for the duration of study drug. Receiver operating characteristic (ROC) analysis was used to evaluate the accuracy of these for the diagnosis of IFIs.. Overall, 46.4% of the patients at baseline had positive GM (index ≥ 0.5) and 89.6% had BG of 80 pg/mL or greater with BG level of 500 pg/mL or greater in 31.8%. Patients with invasive aspergillosis (IA) (3/3) had positive GM at baseline as did 45.5% of those without IA (P = 0.098); the area under the ROC curve for the diagnosis of IA was 0.77 (fair test, ie, good sensitivity but poor specificity). Using BG cutoff of 80 pg/mL or higher, 100% (12/12) of the patients with IFI had positive baseline BG and as did 88.9% (160/180) of those without IFI (P = 0.618); the area under the ROC curve for predicting IFIs was 0.56 (poor test). In multivariate analyses, GM positivity was associated with study site (P = 0.041), and BG positivity with renal replacement therapy (P = 0.05) and study site (P = 0.01). The GM and BG levels declined over time; positivity at subsequent time points was lower in comparison with baseline (P < 0.001).. The GM and BG tests had significant center variability and limited accuracy for the diagnosis of IFIs in high-risk liver transplant recipients.

Topics: Adult; Aged; Antifungal Agents; Aspergillosis; beta-Glucans; Double-Blind Method; Female; Follow-Up Studies; Galactose; Humans; Liver Transplantation; Male; Mannans; Middle Aged; Postoperative Complications; Prospective Studies; Proteoglycans; Risk Factors; ROC Curve; Young Adult

Patients undergoing emergency gastrointestinal surgery for intra-abdominal infection are at risk of invasive candidiasis (IC) and candidates for preemptive antifungal therapy.. This exploratory, randomized, double-blind, placebo-controlled trial assessed a preemptive antifungal approach with micafungin (100 mg/d) in intensive care unit patients requiring surgery for intra-abdominal infection. Coprimary efficacy variables were the incidence of IC and the time from baseline to first IC in the full analysis set; an independent data review board confirmed IC. An exploratory biomarker analysis was performed using logistic regression.. The full analysis set comprised 124 placebo- and 117 micafungin-treated patients. The incidence of IC was 8.9% for placebo and 11.1% for micafungin (difference, 2.24%; [95% confidence interval, -5.52 to 10.20]). There was no difference between the arms in median time to IC. The estimated odds ratio showed that patients with a positive (1,3)-β-d-glucan (ßDG) result were 3.66 (95% confidence interval, 1.01-13.29) times more likely to have confirmed IC than those with a negative result.. This study was unable to provide evidence that preemptive administration of an echinocandin was effective in preventing IC in high-risk surgical intensive care unit patients with intra-abdominal infections. This may have been because the drug was administered too late to prevent IC coupled with an overall low number of IC events. It does provide some support for using ßDG to identify patients at high risk of IC.. NCT01122368.

Topics: Adolescent; Adult; Aged; Antifungal Agents; beta-Glucans; Biomarkers; Candidiasis, Invasive; Double-Blind Method; Echinocandins; Female; Humans; Intensive Care Units; Intraabdominal Infections; Lipopeptides; Male; Micafungin; Middle Aged; Postoperative Complications; Pre-Exposure Prophylaxis; Proteoglycans; Young Adult

Invasive fungal infection (IFI) related to surgery in elderly patients is often associated with high morbidity and mortality. The aim of the present study was to determine 1,3-β-D-glucan (βDG) levels after gastric cancer surgery in elderly patients and to prospectively evaluate the efficacy of pre-emptive antifungal therapy using βDG as an aid for the early diagnosis of IFI.. In all, 81 patients aged ≥70 years who had undergone gastric cancer surgery between 2009 and 2011 were prospectively enrolled in the study. Patients with plasma βDG levels >11 pg/mL (the cut-off value) were randomly assigned to either receive antifungal treatment or not (n=13 in each group). Postoperative outcomes were assessed using various clinical parameters.. After gastric cancer surgery, plasma βDG levels were ≥11 pg/mL in 26 of 81 elderly patients (32.1%). Of the βDG-positive patients, significantly more had stages III and IV rather than stages I and II disease (44.1% vs 23.4%, respectively; P=0.049). Fever on postoperative day 8 was significantly reduced in the pre-emptive antifungal-treated group than in the control group (36.8°C vs 37.2°C, respectively; P=0.045). However, there were no significant differences in mortality, morbidity, βDG levels, white blood cell count, and C-reactive protein levels between the two groups.. Pre-emptive antifungal treatment based on βDG after gastric surgery in elderly patients may help reduce the incidence of postoperative fever and suppress IFI. However, this needs to be confirmed in a larger prospective randomized, controlled trial.

Topics: Aged; Aged, 80 and over; Antifungal Agents; beta-Glucans; Biomarkers; Early Diagnosis; Female; Gastrectomy; Humans; Male; Mycoses; Neoplasm Staging; Perioperative Care; Postoperative Complications; Prospective Studies; Proteoglycans; Stomach Neoplasms; Treatment Outcome

Postoperative infections remain common after high-risk gastrointestinal procedures. PGG-glucan (Betafectin; Alpha Beta Technology Inc, Worcester, Mass), derived from yeast cell walls, promotes phagocytosis and intracellular killing of bacterial pathogens by leukocytes, prevents infection in an animal model of wound infection, and acts synergistically with antibiotics to reduce mortality in rat peritonitis.. We hypothesized that infectious complications in these patients might be reduced by the administration of a nonspecific immune-enhancing agent.. Multicenter, prospective, randomized, double-blind, placebo-controlled trial of 1249 patients prospectively stratified into colorectal or noncolorectal strata.. Thirty-nine medical centers throughout the United States.. Aged 18 years or older, scheduled for gastrointestinal procedure lasting 2 to 8 hours, with 2 or more defined risk factors.. PGG-glucan, 0.5 mg/kg or 1.0 mg/kg, or placebo once preoperatively and 3 times postoperatively. All patients received standardized antibiotic prophylaxis.. Serious infection or death within 30 days.. All randomized patients revealed no difference in serious infections and deaths in the treated groups compared with placebo groups (15% vs 14%, P>.90). In the prospectively defined noncolorectal stratum (n = 391), PGG-glucan administration was associated with a statistically significant relative reduction (39%) in serious infections and death (placebo, 46 [36%] of 129 vs either PGG-glucan group, 29 [21%] of 132 and 28 [22%] of 130, P<.02). PGG-glucan reduced postoperative infection or death in malnourished patients having noncolorectal procedures (31 [44%] of 70, placebo group; 16 [24%] of 68, 0.5-mg/kg PGG-glucan group; 12 [17%] of 72, 1.0-mg/kg PGG-glucan group; P<.001). Study drug was stopped owing to adverse effects more frequently for patients receiving PGG-glucan than placebo (2%, 4%, and 7% for the placebo group, 0.5-mg/kg PGG-glucan group, and 1.0-mg/kg PGG-glucan group, respectively, P<.003).. Perioperative administration of PGG-glucan reduced serious postoperative infections or death by 39% after high-risk noncolorectal operations.

Topics: Adjuvants, Immunologic; Adult; Bacterial Infections; beta-Glucans; Digestive System Surgical Procedures; Glucans; Humans; Middle Aged; Postoperative Complications; Prospective Studies; Risk Factors

The safety and efficacy of PGG-glucan in surgical patients at high risk for postoperative infection who underwent major thoracic or abdominal surgery were determined.. Recent studies have reported a 25% to 27% infectious complication rate in patients undergoing major surgery with an average cost per infected patient of $12,000. The efficacy of PGG-glucan pretreatment in prevention of sepsis has been demonstrated in rodent models for gram-negative and gram-positive bacterial and yeast infections. In vitro studies have demonstrated enhanced microbial killing by monocytes and neutrophils in healthy volunteers after PGG-glucan administration. Thus, PGG-glucan may play a role in decreasing the infectious complication rate in patients undergoing major surgery.. A double-blind, placebo-controlled randomized study was performed in 34 high-risk patients undergoing major abdominal or thoracic surgery.. There were no adverse drug experiences associated with PGG-glucan infusion. Patients who received PGG-glucan had significantly fewer infectious complications (3.4 infections per infected patient vs. 1.4 infections per infected patient, p = 0.05), decreased intravenous antibiotic requirement (10.3 days vs. 0.4 days, p = 0.04) and shorter intensive care unit length of stay (3.3 days vs. 0.1 days, p = 0.03).. PGG-glucan is safe and appears to be effective in the further reduction of the morbidity and cost of major surgery.

Topics: Abdomen; Adjuvants, Immunologic; Aged; beta-Glucans; Double-Blind Method; Follow-Up Studies; Glucans; Humans; Infections; Middle Aged; Postoperative Complications; Premedication; Risk Factors; Thoracic Surgery

To examine the safety and efficacy of multiple doses of PGG-glucan (poly-[1-6]-B-D-glucopyranosyl-[1-3]-B-D-glucopyranose) in high-risk patients undergoing major thoracic or abdominal surgery.. An interventional, multicenter, double-blind, randomized, placebo-controlled study.. Four university-affiliated medical centers.. Sixty-seven high-risk patients undergoing major thoracic or abdominal surgery.. Patients were randomized in a 1:1:1:1 ratio to receive saline placebo or PGG-glucan at a dose of 0.1 mg/kg, 0.5 mg/kg, and 1.0 mg/kg or 2.0 mg/kg. One dose was administered before surgery and three doses were administered after surgery.. To examine the safety and efficacy of PGG-glucan infusion and to identify potentially important factors for a planned phase III study.. A dose-response trend with regard to infection incidence among patients who received PGG-glucan was observed. Serious infections occurred in four patients who received placebo and in three patients who received PGG-glucan at a dose of 0.1 mg/kg. However, only one patient who received PGG-glucan at a high dose had a serious infection. The incidence and severity of adverse events was comparable in all groups.. PGG-glucan was generally safe and well tolerated, may decrease postoperative infection rates, and warrants further investigation in a planned phase III trial.

Topics: Adjuvants, Immunologic; Adult; Aged; Bacterial Infections; beta-Glucans; Dose-Response Relationship, Drug; Double-Blind Method; Female; Glucans; Humans; Incidence; Male; Middle Aged; Postoperative Complications; Premedication

The patient was a 45-year-old man with underlying alcoholic liver cirrhosis. Two years prior, he was repeatedly hospitalized for liver failure symptoms and requested a living-donor liver transplantation (LDLT) because of end-stage cirrhosis. A pretransplantation blood test revealed a high 1,3-beta-d-glucan (BDG) value of 102.0 pg/mL (reference value <20.0 pg/mL) and a high blood Aspergillus antigen (AsAg) value of 1.6 cutoff index (COI; reference value <0.5 COI). Contrast-enhanced thoracoabdominal-pelvic computed tomography (CT) and cranial magnetic resonance imaging revealed no fungal infection. However, latent fungal infection could not be ruled out, hence preoperative antifungal agent treatment was administered. BDG and AsAg levels showed a decreasing trend after treatment initiation. However, normalization did not occur; the BDG and AsAg levels were 25.8 pg/mL and 1.0 COI, respectively. Although the possibility of latent fungal infection was judged low, we prophylactically administered antifungal agents after LDLT. The BDG level consistently increased at 35-39 pg/mL until postoperative day 5 but subsequently normalized. The AsAg level was higher than the limit of detection at 5.0 COI on postoperative day 3 but normalized to 0.2 COI on postoperative day 5 and did not subsequently increase. The postoperative course was uneventful despite bacterial pneumonia and the patient was discharged on postoperative day 35. A histopathologic examination (Grocott methenamine silver staining) and a fungal polymerase chain reaction assay were performed for the resected liver, but the results of both were negative. At 9 postoperative months, the patient was making ambulatory follow-up visits. Currently, the BDG and AsAg values remain normal and clinical progress is favorable. We found no reports of LDLT for a recipient with a high preoperative BDG level and positive test result for AsAg. Thus, we report on such a case with a discussion of the literature on the causes of high preoperative BDG and AsAg values.

Topics: Antifungal Agents; Antigens, Fungal; Aspergillosis; Aspergillus; beta-Glucans; Biomarkers; Humans; Liver Transplantation; Living Donors; Male; Middle Aged; Postoperative Care; Postoperative Complications; Preoperative Care; Proteoglycans

Currently, it is important to identify a good biomarker to predict treatment-related complications in patients with transplantation. This study aimed to evaluate the significance of serum hepcidin-25 in predicting invasive fungal disease (IFD) after transplantation.. A total of 57 patients who underwent transplantation were included in this study, and their serum samples were obtained and stored at -80°C for analysis. The serum hepcidin-25 were assayed using enzyme-liked immunosorbent assay (ELISA), and hypersensitive C reactive protein (hsCRP) and 1,3-beta-D glucan were measured using standard laboratory techniques. These indices were monitored weekly, from one week before transplantation to four weeks after transplantation.. The median pretransplant serum hepcidin-25 level was 37.00 ng/mL which was higher than that of healthy volunteers (p < 0.001). Because the higher hepcidin-25 level of the third tertile among the patients was 39.855 ng/mL, we set a cutoff level of 40 ng/mL to divide them into low- and high-hepcidin-25 groups (n = 38 and 19, respectively). The prevalences of the documented infection in the two groups were 2.6% and 26%, respectively (p = 0.019). The high-hepcidin-25 group was monitored after transplantation. The hepcidin-25 level peaked one week after transplantation, followed by gradual decrease. The plasma (1-3)-beta-D-glucan reached the summit two week. The proven of IFD was delayed 10 days on average after hepcidin-25 had arrived summit and 5 days after (1-3)-beta-D-glucan peaked..  The pretransplant serum hepcidin-25 level would be a useful indicator for predicting the risk of infection after transplantation; and the dynamic changes of hepcidin-25 in patients with high-hepcidin-25 group would help to predict IFD after transplantation.

Topics: Adult; Aged; Antimicrobial Cationic Peptides; beta-Glucans; Biomarkers; C-Reactive Protein; Female; Hepcidins; Humans; Male; Middle Aged; Mycoses; Organ Transplantation; Postoperative Complications; Predictive Value of Tests; Young Adult

To evaluate the significance of a serum 1,3-beta-D-glucan (BG) assay for early diagnosis of invasive fungal infection (IFI) and determine its cutoff value in Chinese post-hematopoietic stem cell transplant (HSCT) recipients.. Serum BG levels were measured twice weekly by Glucatell kit (G-Test) in 36 post-HSCT patients with suspected IFI. The sensitivities and specificities of the assay for clinical proven IFI and non-IFI patients were calculated retrospectively according to different G-Test positive criteria and determined its cutoff.. The sensitivity, specificity, positive and negative predictive values were 81.0%, 81.8%, 89.5% and 69.2% (P=0.002) respectively, as the cutoff value was set at more than 80 ng/L once or 60 ng/L consecutively twice.. The cutoff value of G test in Chinese post HSCT patients basically is the same as specified in the instruction of the kit, and it is a quick and reliable method for early diagnosis of IFI.

Topics: beta-Glucans; Early Diagnosis; Female; Hematopoietic Stem Cell Transplantation; Humans; Male; Mycoses; Postoperative Complications; Predictive Value of Tests; Proteoglycans; Sensitivity and Specificity

Pneumocystis carinii pneumonia (PCP) is one of the fatal complications encountered after liver transplantation. The diagnosis of PCP is sometimes very difficult, because detection of the bacteria itself is not easy under some conditions, and the serum level of the chemical mediator is not yet considered to be a definitive diagnostic marker. We report a case of PCP that occurred 3 months after transplantation in a living-donor liver-transplant recipient; the disease developed during the course of outpatient follow-up when the patient's condition was stable. The patient was maintained with the usual level of immunosuppressants, using tacrolimus, steroid, and mycophenolate mofetil. The patient had a dry cough with mild fever, and a chest computed tomography (CT) scan showed a reticular shadow in the left lung field. The plasma level of beta-D: glucan was high (135 pg/ml). We suspected an invasive fungal infection, but no pathogen was detected by routine fungal culture and cytology. Finally, P. carinii was detected by polymerase chain reaction (PCR), and we started treatment with trimethoprim-sulfamethoxazole (TMP/SMX) combined with an antifungal agent. During this period, the level of beta-D: glucan correlated with the patient's clinical symptoms; this marker was very useful for monitoring the treatment of PCP in this living-donor liver-transplant recipient.

Topics: Antifungal Agents; beta-Glucans; Diagnosis, Differential; DNA, Fungal; Humans; Liver Failure, Acute; Liver Transplantation; Living Donors; Male; Middle Aged; Pneumocystis carinii; Pneumonia, Pneumocystis; Polymerase Chain Reaction; Postoperative Complications; Tomography, X-Ray Computed

In colorectal surgery, anastomotic failure is still a problem in ischemia. Here,we analyzed the effects of hyperbaric oxygen and beta-glucan on colon anastomoses in ischemic condition.. Colonic resection and anastomosis in rectosigmoid region were done in forty Wistar-Albino rats of four groups of equal number. Colon mesentery was ligated to induce ischemia. The first group was the control group. The subjects of second group were treated with hyperbaric oxygen;the third group with glucan and the forth group were treated with both. At the forth day, rats were sacrificed,anastomotic segment was resected and burst pressures and hydroxyproline levels of anastomotic line were measured.. The burst pressure difference of second and third groups from the control group were meaningful (P<0.01); the forth group differed significantly from the control (P<0.001). There was no difference between the treated groups on burst pressure level (P>0.05). The hydroxyproline levels in all treated groups were different from the control group significantly (P<0.001). Hydroxyproline levels in the forth group were higher than those of the second and the third groups (P<0.001). There were no significant differences between the second and the fourth groups in burst pressure and hydroxyproline levels (P>0.05).. Hyperbaric oxygen and glucan improve healing in ischemic colon anastomoses by anti-microbic,immune stimulating properties and seem to act synergistically when combined together.

Topics: Anastomosis, Surgical; Animals; beta-Glucans; Colon; Combined Modality Therapy; Female; Hydroxyproline; Hyperbaric Oxygenation; Ischemia; Oxygen; Postoperative Complications; Pressure; Rats; Rats, Wistar

The purpose of the study was to investigate whether examination for plasma beta-D-glucan, a cell wall constituent of fungi, is useful for selecting surgical patients with Candida colonization who would benefit from empiric antifungal therapy. We administered fluconazole to postoperative patients with Candida colonization who have risk factors for candidemia and complained of persistent fever despite prolonged antibacterial therapy. We then analyzed the clinical outcomes regarding the number of sites colonized with Candida spp. and plasma beta-D-glucan. Of the 32 patients positive for alpha-D-glucan, 15 (46.9%) responded to the empiric therapy; only 9% of those who were negative responded (p < 0.01). In the multiple logistic regression analysis, being positive for alpha-D-glucan was a significant factor predicting response, with an adjusted odds ratio of 12.9 in patients with Candida colonization [95% confidence interval (CI) 2.07-80.73) (p < 0.01). In addition, the number of sites colonized with Candida spp. was a significant factor predicting response, with an estimated exposure odds ratio of 7.57 for those who were colonized at three or more sites compared with those colonized at one site (95% CI 1.20-47.70) (p = 0.031). In patients with Candida colonization, assessment of beta-D-glucan was useful for deciding whether to start empiric therapy for suspected candidiasis in surgical patients.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Antifungal Agents; Ascomycota; beta-Glucans; Candidiasis; Female; Fluconazole; Glucans; Humans; Logistic Models; Male; Middle Aged; Odds Ratio; Patient Selection; Postoperative Complications; Predictive Value of Tests; Prospective Studies; Treatment Outcome

Topics: Adjuvants, Immunologic; beta-Glucans; Cytokines; Glucans; Humans; Postoperative Complications; Sepsis