SERUM GALACTOMANNAN AND (1-3)-Β-D-GLUCAN DETECTION FOR THE EARLY DIAGNOSIS OF INVASIVE ASPERGILLOSIS
Main Article Content
Keywords
Invasive aspergillosis, Galactomannan, B-D-Glucan, bronchoalveolar lavage, sputum, serum, cerebrospinal fluid
Abstract
Background
Invasive aspergillosis (IA) stands as one of the most common fungal infections among immunocompromised and high-risk patients. Early detection and swift antifungal treatment may enhance patient outcomes. The guidelines incorporated microbiological criteria using GM and BG tests to identify invasive fungal infections and probable IA in immunocompromised patients. The present study aimed to detect the presence of IA via GM and BDG tests in a plethora of patients.
Materials and methods
After the approval from the institutional review board, the specimens (BAL, serum, CSF, and sputum) were collected from various hospitals of the Karachi from patients irrespective of their age or gender. The BDG was evaluated using the lateral flow methodology and GM was detected via the chromogenic method.
Results
Of the total 820 samples, the frequency of various specimens revealed bronchoalveolar lavage (n=412) as the majority followed by serum (n=268), sputum (n=80), and cerebrospinal fluid (n=60). Results showed that BDG exhibited higher sensitivity (97.8%) compared to Galactomannan (91.8%). In BAL samples, GM identified 384 cases, with 93% (304/325) confirmed, while BDG detected 410 positive cases, of which 99.6% (324/325) were proven IA cases. For serum samples, GM identified 264 cases, with 82% (13/16) confirmed, whereas BDG detected 257 positive cases, all of which (16/16) were proven IA cases. In CSF samples, GM identified 52 cases, with 86.8% (33/38) confirmed, while BDG detected 57 positive cases, of which 94.7% (36/38) were proven IA cases. Lastly, in sputum samples, GM identified 71 cases, with 91.4% (48/51) confirmed, whereas BDG detected 78 positive cases, all of which (51/51) were proven IA cases.
Conclusion
Invasive aspergillosis is a fatal fungal infection that remains an important cause of illness and death in immunocompromised patients; the development of early and sound diagnostic strategies remains pivotal. It has been aimed in this research to explore the role of serum galactomannan and β-D-glucan tests as diagnostic markers for the early diagnosis of this lethal fungal infection. This analysis shows that both biomarkers are useful in the assessment of the diagnostics, although they incorporate different strengths and weaknesses. Both approaches, when used simultaneously and in conjunction with clinical and radiographic examinations, present a viable system to enable timely diagnosis and monitoring of this challenging fungal disease.
References
1. Ruhnke M, Behre G, Buchheidt D, Christopeit M, Hamprecht A, Heinz W, et al. Diagnosis of invasive fungal diseases in haematology and oncology: 2018 update of the recommendations of the infectious diseases working party of the German society for hematology and medical oncology (AGIHO). Mycoses. 2018;61(11):796-813.https://doi.org/10.1111/myc.12838
2. Jenks JD, Mehta SR, Hoenigl M. Broad spectrum triazoles for invasive mould infections in adults: Which drug and when? Med Mycol. 2019;57(Supplement_2):S168-S178.https://doi.org/10.1093/mmy/myy052
3. Cadena J, Thompson GR, 3rd, Patterson TF. Invasive Aspergillosis: Current Strategies for Diagnosis and Management. Infect Dis Clin North Am. 2016;30(1):125-142.https://doi.org/10.1016/j.idc.2015.10.015
4. Lamoth F, Calandra T. Pulmonary aspergillosis: diagnosis and treatment. Eur Respir Rev. 2022;31(166):220114.https://doi.org/10.1183/16000617.0114-2022
5. Mercier T, Maertens J. Clinical considerations in the early treatment of invasive mould infections and disease. J Antimicrob Chemother. 2017;72(suppl_1):i29-i38.https://doi.org/10.1093/jac/dkx031
6. Douglas AP, Smibert OC, Bajel A, Halliday CL, Lavee O, McMullan B, et al. Consensus guidelines for the diagnosis and management of invasive aspergillosis, 2021. Intern Med J. 2021;51 Suppl 7(S7):143-176.https://doi.org/10.1111/imj.15591
7. Jenks JD, White PL, Kidd SE, Goshia T, Fraley SI, Hoenigl M, et al. An update on current and novel molecular diagnostics for the diagnosis of invasive fungal infections. Expert Rev Mol Diagn. 2023;23(12):1135-1152.https://doi.org/10.1080/14737159.2023.2267977
8. Jenks JD, Hoenigl M. Point-of-care diagnostics for invasive aspergillosis: nearing the finish line. Expert Rev Mol Diagn. 2020;20(10):1009-1017.https://doi.org/10.1080/14737159.2020.1820864
9. Lamoth F, Calandra T. Early diagnosis of invasive mould infections and disease. J Antimicrob Chemother. 2017;72(suppl_1):i19-i28.https://doi.org/10.1093/jac/dkx030
10. Lamoth F, Lewis RE, Kontoyiannis DP. Role and Interpretation of Antifungal Susceptibility Testing for the Management of Invasive Fungal Infections. J Fungi (Basel). 2020;7(1):17.https://doi.org/10.3390/jof7010017
11. Arastehfar A, Carvalho A, Houbraken J, Lombardi L, Garcia-Rubio R, Jenks JD, et al. Aspergillus fumigatus and aspergillosis: From basics to clinics. Stud Mycol. 2021;100:100115.https://doi.org/10.1016/j.simyco.2021.100115
12. Wang Y, Zhang L, Zhou L, Zhang M, Xu Y. Epidemiology, Drug Susceptibility, and Clinical Risk Factors in Patients With Invasive Aspergillosis. Front Public Health. 2022;10:835092.https://doi.org/10.3389/fpubh.2022.835092
13. Yu SY, Guo LN, Xiao M, Zhou ML, Yuan Y, Wang Y, et al. Clinical and Microbiological Characterization of Invasive Pulmonary Aspergillosis Caused by Aspergillus lentulus in China. Front Microbiol. 2020;11:1672.https://doi.org/10.3389/fmicb.2020.01672
14. Jenks JD, Cornely OA, Chen SC, Thompson GR, 3rd, Hoenigl M. Breakthrough invasive fungal infections: Who is at risk? Mycoses. 2020;63(10):1021-1032.https://doi.org/10.1111/myc.13148
15. Stemler J, Tobben C, Lass-Florl C, Steinmann J, Ackermann K, Rath PM, et al. Diagnosis and Treatment of Invasive Aspergillosis Caused by Non-fumigatus Aspergillus spp. J Fungi (Basel). 2023;9(4):500.https://doi.org/10.3390/jof9040500
16. Theel ES, Doern CD. beta-D-glucan testing is important for diagnosis of invasive fungal infections. J Clin Microbiol. 2013;51(11):3478-3483.https://doi.org/10.1128/JCM.01737-13
17. Fernandez-Pittol M, Alejo-Cancho I, Rubio-Garcia E, Cardozo C, Puerta-Alcalde P, Moreno-Garcia E, et al. Aspergillosis by cryptic Aspergillus species: A case series and review of the literature. Rev Iberoam Micol. 2022;39(2):44-49.https://doi.org/10.1016/j.riam.2022.04.002
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Mubarak Zeb
Department of Microbiology, University of Sindh, Jamshoro, Sindh, Pakistan.Agha Asad Noor
Department of Microbiology, University of Sindh, Jamshoro, Sindh, Pakistan.
Nazeer Ahmed
Department of Microbiology, University of Sindh, Jamshoro, Sindh, Pakistan