galactomannan and Pulmonary-Disease--Chronic-Obstructive

Native valve endocarditis caused by Aspergillus spp. is an uncommon disease with a high mortality rate. Generally, Aspergillus is isolated from affected valve in post-mortem or biopsy specimens. However, its isolation from blood cultures is exceedingly rare. We report a case of fungal endocarditis in a native mitral valve with the isolation of Aspergillus fumigatus both in valve vegetation and in blood culture bottles. The patient underwent valve replacement and antifungal treatment with voriconazole and caspofungin, but he died on post-operative day 45 with disseminated aspergillosis confirmed by necropsy. Paradoxically, galactomannan antigen detection in serum was negative. This is the third case of Aspergillus endocarditis with positive blood culture reported in the literature.

Topics: Amaurosis Fugax; Aneurysm, Infected; Antifungal Agents; Antigens, Fungal; Aspergillosis; Aspergillus fumigatus; Biomarkers; Caspofungin; Combined Modality Therapy; Echinocandins; Endocarditis; False Negative Reactions; Fatal Outcome; Fungemia; Galactose; Heart Valve Prosthesis Implantation; Humans; Infarction; Kidney; Lipopeptides; Male; Mannans; Mesenteric Arteries; Mesenteric Vascular Occlusion; Middle Aged; Mitral Valve; Peptides, Cyclic; Pulmonary Disease, Chronic Obstructive; Pyrimidines; Renal Artery; Triazoles; Voriconazole

Over the last 3 years, there has been a proliferation of legislation aimed at restricting the rights of transgender Americans, including their access to gender-affirming health care. While the health implications of not having access to gender-affirming care are well documented, there may be additional indirect harms associated with proposing this type of legislation, such as those associated with being exposed to negative messages about transgender people or having to contend with friends and family who support the legislation.. Results showed that news consumption was associated with increased rumination and physical health symptoms and that perceived support for the legislation was associated with greater rumination, depressive symptoms, physical health symptoms, and fear of disclosing one's identity. Themes from the open-ended questions further underscored that the current legislation has impacted transgender youth and young adults' access to general health care; increased experiences of discrimination and other maltreatment; and resulted in some respondents engaging in unhealthy coping responses.. Policy makers should consider these adverse consequences when responding to current, and crafting future, legislation directed at transgender Americans.. Supplementary material is available in the online version of this article at 10.1007/s11814-023-1461-8.. Hyperglycemia at admission was associated with poor outcomes in COVID-19 patients, even in those without known pre-existing diabetes. Glycemic testing should be recommended for all COVID-19 patients.. Intermittent relacorilant + nab-paclitaxel improved PFS, DOR, and OS compared with nab-paclitaxel monotherapy. On the basis of protocol-prespecified Hochberg step-up multiplicity adjustment, the primary end point did not reach statistical significance (

Topics: Acute Kidney Injury; Adult; Aged; Albumins; Alloys; Amides; Amino Acids; Animals; Antineoplastic Combined Chemotherapy Protocols; Antioxidants; Bioaccumulation; Blood Glucose; Brain; Brassica napus; Breast Neoplasms; Carcinoma, Ovarian Epithelial; Catalysis; Child; China; Chlorides; Chlorine; Chromium; Chronic Disease; Cohort Studies; Copper; Corrosion; COVID-19; Creatinine; Dermatitis; Diabetes Mellitus; Diazepam; Disease-Free Survival; DNA Repair; DNA-(Apurinic or Apyrimidinic Site) Lyase; Dyspnea; Electron Spin Resonance Spectroscopy; Environmental Monitoring; Escherichia coli; Escherichia coli Infections; Esophageal Neoplasms; Esophagogastric Junction; Estradiol; Exercise Test; Exercise Tolerance; Female; Ferric Compounds; Fishes; Food Chain; gamma-Aminobutyric Acid; Genomics; Halogenation; HEK293 Cells; Hemolysis; Heterocyclic Compounds; Hospitalization; Humans; Hydrogen Peroxide; Hyperglycemia; Introns; Iron; Kidney; Kinetics; Laboratories; Limit of Detection; Lipopolysaccharides; Liver Neoplasms; Magnesium; Male; Mammals; Materials Testing; Mercury; Metal-Organic Frameworks; Methylmercury Compounds; Mice; Microscopy, Electron, Scanning; Mifepristone; Minerals; Molecular Weight; Mutation; Nanoparticles; Neuroprotection; NF-kappa B; Nitrates; Nitrogen; NLR Family, Pyrin Domain-Containing 3 Protein; Orthopedics; Ovarian Neoplasms; Ovariectomy; Oxidation-Reduction; Oxidative Stress; Oxygen; Oxygen Consumption; Paclitaxel; Phenols; Progesterone; Prospective Studies; Proteins; Protons; Pulmonary Disease, Chronic Obstructive; Ramucirumab; Rats; Receptor, ErbB-2; Respiratory Function Tests; Retrospective Studies; Saliva; SARS-CoV-2; Seeds; Sesbania; Shock, Septic; Silicon Dioxide; Sleep; Soil; Specimen Handling; Spectroscopy, Mossbauer; Spin Labels; Staphylococcus aureus; Stomach Neoplasms; Streptococcus mutans; Thiamine; Toll-Like Receptor 2; Toll-Like Receptor 4; Trastuzumab; Tumor Microenvironment; Tumor Necrosis Factor-alpha; Ubiquitin-Protein Ligases; Water; Water Pollutants, Chemical; Water Purification; Xeroderma Pigmentosum; Zebrafish

Recent studies have shown that the microbiome, namely Aspergillus species, play a previously unrecognized role in both stable and exacerbated chronic obstructive pulmonary disease (COPD). Galactomannan is a major component of the Aspergillus cell wall that has been widely used as a diagnostic marker.. To explore whether serum levels of Aspergillus-galactomannan antigen could be used to evaluate the risk of severe acute exacerbation of COPD (AE-COPD).. We measured the Aspergillus-galactomannan antigen levels of 191 patients with stable COPD, and examined its clinical relevance including AE-COPD.. There were 77 (40.3%) patients who were positive for serum Aspergillus-galactomannan antigen (≥0.5). High Aspergillus-galactomannan antigen level (≥0.7) was associated with older age and presence of bronchiectasis and cysts on computed tomography images. Compared to patients with low Aspergillus-galactomannan antigen level (<0.7), patients with high Aspergillus-galactomannan antigen level had significantly higher incidence of severe AE-COPD (P = 0.0039, Gray's test) and respiratory-related mortality (P = 0.0176, log-rank test). Multivariate analysis showed that high Aspergillus-galactomannan antigen level was independently associated with severe AE-COPD (hazard ratio, 2.162; 95% confidence interval, 1.267-3.692; P = 0.005).. Serum Aspergillus-galactomannan antigen was detected in patients with COPD, and elevated serum Aspergillus-galactomannan antigen was associated with severe AE-COPD.

Topics: Adult; Aged; Aged, 80 and over; Antigens, Fungal; Aspergillosis; Aspergillus; Disease Progression; Female; Galactose; Humans; Male; Mannans; Middle Aged; Propensity Score; Pulmonary Disease, Chronic Obstructive; Retrospective Studies; Severity of Illness Index

The use of galactomannan (GM) testing in plasma and bronchoalveolar lavage fluid (BALF) has improved the diagnosis of invasive pulmonary aspergillosis (IPA) in patients with chronic obstructive pulmonary disease (COPD); however, the high false-positive rate leads to overdiagnosis. Pentraxin 3 (PTX3) as an indicator of inflammation plays an important role in resistance to Aspergillus infections. This study aimed to investigate the diagnostic value of PTX3 for diagnosing IPA with COPD.. We retrospectively collected data on patients with suspected COPD and IPA who had been hospitalized in the Third Affiliated Hospital of Soochow University between September 2017 and November 2020. PTX3 and GM were measured using enzyme-linked immunosorbent assays.. A total of 165 patients were included in the study, of whom 35 had confirmed or probable IPA. The remaining 130 patients served as controls. The median plasma and BALF PTX3 levels were significantly higher in patients with IPA than in control patients (3.74 ng/mL vs. 1.29 ng/mL, P < 0.001; and 3.88 ng/mL vs. 1.58 ng/mL, P < 0.001 in plasma and BALF, respectively). The plasma GM, plasma PTX3, BALF GM, and BALF PTX3 assays had sensitivities of 60.0%, 77.1%, 78.6%, and 89.3%, respectively, and specificities of 73.8%, 69.2%, 80.7%, and 77.1%, respectively. The sensitivity of PTX3 in plasma and BALF was higher than that of GM. However, the specificity of PTX3 and GM did not differ significantly between the IPA group and the control group. The specificity of the assays for the diagnosis of IPA was > 90% in patients who were PTX3-positive and GM-positive in plasma and BALF.. BALF and plasma PTX3 levels were significantly higher in COPD patients with IPA. The sensitivity of PTX3 was superior to that of GM for diagnosing IPA in patients with COPD. The combination of GM and PTX3 is useful for the diagnosis of IPA in patients with COPD.

Topics: Aged; Aged, 80 and over; Aspergillosis; Biomarkers; Bronchoalveolar Lavage Fluid; C-Reactive Protein; China; Diagnosis, Differential; Female; Galactose; Humans; Male; Mannans; Middle Aged; Pulmonary Disease, Chronic Obstructive; Retrospective Studies; Serum Amyloid P-Component

Among immunologically normal hosts, patients with chronic obstructive pulmonary disease (COPD) are considered to be at high risk of invasive pulmonary aspergillosis (IPA), and early diagnosis and treatment are the key to improving the prognosis of patients. Here we aimed to evaluate whether interleukin (IL)-6 and IL-8 might be used in the detection and diagnosis of IPA in patients with COPD. We prospectively collected 106 patients with COPD and divided them into non-IPA (n=74), probable/possible IPA (n=26) and proven IPA (n=6). Platelia Aspergillus kit was used to detect galactomannan in bronchoalveolar lavage fluid (BALF), and serum and ELISA kit was used to detect IL-6 and IL-8 levels. Diagnostic efficiency of IL-6, IL-8 and galactomannan in serum and BALF was evaluated by receiver operating characteristic curve. Compared with the non-IPA group, the proven/probable IPA group showed significantly elevated levels of IL-6 and IL-8 in both serum and BALF, which were positively correlated with galactomannan levels. The sensitivity and specificity of IL-6 for diagnosing IPA were 74.32% and 81.25% (cut-off at 92.82 pg/mL, area under the curve (AUC)=0.8366) in serum and 68.92% and 71.88% (cut-off at 229.4 pg/mL, AUC=0.7694) in BALF. The sensitivity and specificity of IL-8 for diagnosing IPA were 83.78% and 81.25% (cut-off at 93.46 pg/mL, AUC=0.8756) in serum and 85.14% and 75.00% (cut-off at 325.4 pg/mL, AUC=0.8252) in BALF. The elevated levels of IL-6 and IL-8 in patients with IPA with COPD could be used as auxiliary indicators to diagnose IPA in addition to galactomannan.

Topics: Bronchoalveolar Lavage Fluid; Galactose; Humans; Interleukin-6; Interleukin-8; Invasive Pulmonary Aspergillosis; Mannans; Pulmonary Disease, Chronic Obstructive; Sensitivity and Specificity

The role of

Topics: Adrenal Cortex Hormones; Aged; Aspergillus fumigatus; Biomarkers; Bronchiectasis; Female; Galactose; Humans; Male; Mannans; Middle Aged; Pulmonary Disease, Chronic Obstructive; Sputum

The role of galactomannan (GM) in serum or bronchoalveolar lavage fluid (BALF) for the diagnosis of invasive pulmonary aspergillosis (IPA) has been extensively evaluated in hematological patients, however its performance in non-hematological patients is not well established.. We performed a multicenter retrospective study in 3 university hospitals in Madrid, Spain between 2010 and 2014. The study population comprised patients with chronic obstructive pulmonary disease (COPD) and patients with immunosuppressive conditions in whom IPA was suspected and for whom BALF GM was available. Patients with hematological disorders were excluded.. A total of 188 patients (35 with COPD and 153 with immunosuppressive conditions) were analyzed, and 31 cases of IPA (proven or probable) were identified. The global sensitivity of BALF GM (optical density index [ODI] ≥ 1.0) was 77.4%; sensitivity was higher in patients with immunosuppressive conditions than in patients with COPD (81.8% vs 66.7%; p: 0.38). In COPD patients, the best performance was obtained for BALF GM (ODI ≥ 0.5), although sensitivity (88.9%) was similar to that of BALF fungal culture (88.9%). The sensitivity of GM in serum was very poor in both populations (36.4% and 11.6%, respectively).. In the present series, the diagnostic performance of BALF GM was good for IPA in non-hematological patients, especially in patients with immunosuppressive conditions.

Topics: Adult; Bronchoalveolar Lavage Fluid; Female; Galactose; Humans; Immunocompromised Host; Invasive Pulmonary Aspergillosis; Male; Mannans; Middle Aged; Neutropenia; Pulmonary Disease, Chronic Obstructive; Retrospective Studies; Sensitivity and Specificity; Spain; Young Adult

Critically ill chronic obstructive pulmonary disease (COPD) patients admitted to an intensive care unit (ICU) due to respiratory failure are at particularly high risk of Aspergillus infection. The serum galactomannan index (GMI) has proven to be one of the prognostic criteria for invasive pulmonary aspergillosis (IPA) in classical immunocompromised patients. However, the prognostic value of serum GMI in critically ill COPD patients needs evaluation. The purpose of this study is to investigate the prognostic value of serum GMI in patients with severe COPD.. In this single-center prospective cohort study, serum samples for GMI assay were collected twice a week from the first day of ICU admission to the day of the patients' discharge or death. Patients were divided into two groups according to their clinical outcome on the 28th day of their ICU admission. Univariate analysis and survival analysis were tested in these two groups.. One hundred and fifty-three critically ill COPD patients were included and were divided into survival group (106 cases) and non-survival group (47 cases) according to their outcome. Univariate analysis showed that the highest GMI level during the first week after admission (GMI-high 1st week) was statistically different between the two groups. Independent prognostic factors for poor outcome in severe COPD patients were: GMI-high 1st week >0.5 (RR: 4.04, 95% CI: 2.17-7.51) combined with accumulative dosage of corticosteroids >216 mg before the RICU admission (RR: 2.25, 95% CI: 1.11-4.56) and clearance of creatinine (Ccr) ≤ 64.31 ml/min (RR: 2.48, 95% CI: 1.22 ± 5.07).. The positive GMI-high 1st week (>0.5) combined with an accumulative dosage of corticosteroids >216 mg before the ICU admission and a low Ccr may predicate a poor outcome of critically ill COPD patients.

Topics: Aged; Aged, 80 and over; Critical Illness; Female; Galactose; Humans; Invasive Pulmonary Aspergillosis; Male; Mannans; Middle Aged; Prospective Studies; Pulmonary Disease, Chronic Obstructive

Invasive pulmonary aspergillosis (IPA) is difficult to diagnose in chronic obstructive pulmonary disease (COPD). The aim of this study was to evaluate whether detection of galactomannan (GM) in bronchoalveolar lavage fluid (BALF) might be a useful means of making the diagnosis. Patients with COPD and new pulmonary infiltrates were enrolled. BALF was collected for culture and detection of GM. Venous blood was also sampled for GM detection. Biopsy samples were obtained whenever possible. Eleven cases of IPA were diagnosed (three proven and eight probable); 80 controls without IPA diagnosed were recruited. At a GM cut-off of 0.5, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for diagnosing IPA were 90.9, 66.3, 27.0 and 98.1% in serum, and 90.9, 62.5, 25.0 and 98.0% in BALF, respectively. At a cut-off of 1.0, the specificity, PPV and NPV in BALF increased to 95.0, 71.4 and 98.7%; the sensitivity remained 90.9%. The sensitivity in serum was substantially lower than BALF (45.5% versus 90.9%). Receiver operating characteristic curve analysis identified an optimal BALF GM cut-off value of 1.25, with a sensitivity of 90.9% and a specificity of 96.3% for diagnosing IPA. At a relatively high cut-off value, BALF GM detection is a useful tool for the diagnosis of IPA in COPD. Besides piperacillin-tazobactam and amoxicillin-clavulanate, many other factors may also cause false-positive of GM detection in patients without IPA. Further work is needed to identify factors that might lead to false-positive or false-negative results.

Topics: Adult; Aged; Aged, 80 and over; Biopsy; Blood Chemical Analysis; Bronchoalveolar Lavage Fluid; Clinical Laboratory Techniques; Cohort Studies; Female; Galactose; Humans; Invasive Pulmonary Aspergillosis; Lung; Male; Mannans; Middle Aged; Mycology; Predictive Value of Tests; Prospective Studies; Pulmonary Disease, Chronic Obstructive; ROC Curve; Sensitivity and Specificity

Topics: Antifungal Agents; Aspergillosis; Aspergillus fumigatus; Biomarkers; Cross Infection; Fatal Outcome; Galactose; Haemophilus influenzae; Hepatitis C, Chronic; Humans; Immunocompromised Host; Liver Cirrhosis; Low Back Pain; Lumbar Vertebrae; Male; Mannans; Middle Aged; Multiple Organ Failure; Opportunistic Infections; Pulmonary Disease, Chronic Obstructive; Pyrimidines; Spondylitis; Triazoles; Voriconazole

Emerging reports have associated chronic pulmonary obstructive disease (COPD) with invasive aspergillosis (IA), particularly in patients treated with mechanical ventilation and/or corticosteroids. This is a multicentre study in which COPD patients demonstrating a new lung infiltrate while being mechanically ventilated were prospectively evaluated for the presence of IA. From the 47 patients studied, Aspergillus fumigatus was recovered in culture in two patients (4.2%). While serum galactomannan (GM) was negative for 94% of patients, GM levels in respiratory samples were >0.5, >1.0 and >1.5 for 74.5, 40.5, and 21.3% of patients, respectively. PCR was positive for 10 patients in the study but did not differentiate Aspergillus colonization from infection. The combination of PCR and GM in respiratory samples may be an interesting alternative to diagnose IA in COPD patients.

Topics: Aged; Aged, 80 and over; Aspergillus fumigatus; Cohort Studies; Female; Galactose; Humans; Invasive Pulmonary Aspergillosis; Male; Mannans; Microbiological Techniques; Middle Aged; Mycology; Prospective Studies; Pulmonary Disease, Chronic Obstructive; Real-Time Polymerase Chain Reaction

Critically ill chronic obstructive pulmonary disease (COPD) patients are at particular risk of invasive pulmonary aspergillosis (IPA). Our aims were to determine whether bronchoalveolar lavage fluid (BALF) galactomannan (GM) has a higher sensitivity and specificity than serum GM or lower respiratory tract (LRT) sample culture. Furthermore, we aimed to investigate what the optimal cut-off value would be for BALF GM.. In this prospective single-center study, BALF and serum samples were collected from critically ill COPD patients on the first day of their intensive care unit admission.. Of 50 critically ill COPD patients admitted, BALF and serum samples were collected in 34 patients. According to the receiver operating characteristics (ROC) curve, an optical density (OD) ratio of 0.8 was chosen as the cut-off value for GM in BALF. Compared to serum GM and LRT Aspergillus isolation, BALF GM yield a better sensitivity, specificity, positive and negative predictive values of 88.9%, 100%, 100% and 94.4%, respectively. Areas under the ROC curve were 0.912 (95%CI, 0.733 to 0.985) for BALF GM, and 0.879 (95%CI, 0.691 to 0.972) for serum GM results from the first day of ICU admission. Pairwise comparison of ROC curves showed P = 0.738. The OD ratio of BALF GM in IPA patients were significantly higher than those of non-IPA patients (2.88 ± 2.09 versus 0.49 ± 0.19, P = 0.009), and the OD ratio of BALF GM was significantly higher than serum GM in IPA patients (2.88 ± 2.09 versus 0.87 ± 0.47, P = 0.023). Positive BALF GM was seen earlier than LRT secretion culture (1 day versus 3.8 days).. Compared to serum GM and LRT Aspergillus isolation, BALF GM seems to have a better sensitivity in the diagnosis of IPA in critically ill COPD patients. The ROC curve suggests a possible cut-off value of 0.8 for GM from BALF specimens in critically ill COPD patients.

Topics: Aged; Aged, 80 and over; APACHE; Biomarkers; Bronchoalveolar Lavage Fluid; Bronchoscopy; Critical Illness; Enzyme-Linked Immunosorbent Assay; Female; Galactose; Hospital Mortality; Humans; Intensive Care Units; Invasive Pulmonary Aspergillosis; Male; Mannans; Middle Aged; Mycology; Predictive Value of Tests; Prospective Studies; Pulmonary Disease, Chronic Obstructive; Sensitivity and Specificity

Critically ill chronic obstructive pulmonary disease (COPD) patients who are admitted to intensive care units (ICU) are at particular risk for invasive pulmonary aspergillosis (IPA). The objective of this investigation was to assess the value of consecutive galactomannan (GM) tests in determining the diagnosis and prognosis of IPA in this patient population. We studied 90 critically ill COPD patients admitted to our ICU between February 2007 and November 2009. Two consecutive serum GM tests were done on the first and fourth days of their ICU admissions. Patients were classified as proven IPA (n = 1), probable IPA (n = 18), or non-IPA (n = 71). The sensitivities, specificities, and positive and negative predictive values of GM test results for (i) the first test, (ii) the second test, (iii) at least one positive of two consecutive tests and (iv) two positive consecutive GM tests were, respectively, 57.9%/64.7%/70.6%/47.1%; 87.3%/84.6%/80.8%/94.2%; 55.0%/57.9%/54.5%/72.7%; and 88.6%/88.0%/89.4%/84.5%. The mortality values of IPA patients with (i) a positive first GM test, (ii) at least one of two tests positive, and (iii) both tests positive were (a) 81.8% (9/11), (b) 83.3% (10/12), and (c) 72.7% (8/11), respectively. These results indicate that at least one positive result of two consecutive GM tests appears to be useful in the diagnosis of IPA in critically ill COPD patients in an ICU. In addition, positive serum GM results combined with the isolation of Aspergillus from respiratory samples may be a potential marker of high mortality.

Topics: Aspergillus; Critical Illness; Galactose; Humans; Intensive Care Units; Invasive Pulmonary Aspergillosis; Mannans; Opportunistic Infections; Prognosis; Prospective Studies; Pulmonary Disease, Chronic Obstructive; Sensitivity and Specificity; Sputum