OBJECTIVETo evaluate the clinical value of serum 1,3-beta-D-glucan (BG) and galactomannan (GM) detection for early diagnosis of invasive aspergillosis (IA) in patients after renal transplantation.

METHODSBlood samples collected from 69 renal transplant recipients were divided into diagnosis group, clinical diagnosis group, suspected diagnosis group, and non-infected group for detection of serum BG and GM.

RESULTSThe mean serum levels of BG in the diagnosis group, clinical diagnosis group, and suspected diagnosis group were significantly higher than that in non-infected group (P<0.05). The sensitivity, specificity, and positive and negative predictive values of BG was 69.49%, 70%, 93.18% and 35.71% for IA diagnosis, respectively. The serum levels of GM in the 3 diagnosis groups were also significantly higher than that in the non-infected group (P<0.05) with the sensitivity, specificity, and positive and negative predictive values of 84.75%, 90%, 96.15% and 52.63% for IA diagnosis, respectively.

CONCLUSIONIncreased serum BG and GM levels can serve as the evidence for early diagnosis of IA with a high diagnostic sensitivity and specificity in renal transplant recipients.

Aspergillosis ; diagnosis ; Early Diagnosis ; Humans ; Kidney Transplantation ; Mannans ; blood ; Sensitivity and Specificity ; beta-Glucans ; blood

OBJECTIVE: To evaluate the accuracy and diagnostic value of bronchoalveolar lavage fluid galactomannan test (BALF-GM) combined with serum GM test on invasive pulmonary aspergillosis (IPA). METHODS: 190 cases of BALF-GM and 4 787 cases of serum GM specimens suspected of fungal infection in patients admitted to Affiliated Hospital of Jining Medical University from January 2016 to June 2018 were enrolled and analyzed. All patients were classified into clinically confirmed IPA, clinically diagnosed IPA, suspected IPA and excluded IPA according to the classification standard of Expert consensus on diagnosis and treatment of pulmonary mycosis. The coincidence rate of BALF and serum GM test results with clinical diagnosis was analyzed. Receiver operating characteristic (ROC) curve was performed, and the diagnostic value of BALF and serum GM test alone or in combination for IPA was evaluated. Subgroup analysis was performed in patients with normal or abnormal immune function, and the sensitivity and specificity of BALF and serum GM test were compared separately or jointly. RESULTS: The positive rate of BALF-GM was 46.8% (89/190), and 10.4% (497/4 787) on serum GM. Among them, 156 patients were both tested on BALF and serum GM. There were 44 cases with both positive in BALF and serum GM, the coincidence rate of clinical definite was 93.2% (41/44). There were 34 cases with positive BALF-GM and negative GM test in serum, and the coincidence rate of clinical definite was 64.7% (22/34). There were 56 cases positive in serum GM and negative in BALF-GM, and the coincidence rate of clinical definite was 48.2% (27/56). BALF and serum GM tests were both negative in 22 cases, and the coincidence rate of exclusion diagnosis was 90.9% (20/22). ROC curve analysis showed that the diagnostic value of BALF-GM test combined with serum GM test for IPA was better than that of BALF-GM test or serum GM test alone [area under ROC curve (AUC): 0.992 vs. 0.983, 0.976]. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 95.3%, 87.0%, 93.2% and 90.9%, respectively. Subgroup analysis showed that among 89 patients with positive BALF-GM test, 85 cases (95.5%) had normal immune function and 4 cases (4.5%) had unknown condition. Among 497 patients with positive serum GM test, 12 cases (2.4%) had normal immune function, 372 cases (74.9%) had abnormal immune function and 113 cases (22.7%) were uncertain. It was shown by ROC curve analysis that the sensitivity of positive BALF-GM test in diagnosis of IPA in patients with normal immune function was higher than that of positive serum GM test (95.6% vs. 88.9%), while the sensitivity of positive serum GM test in patients with abnormal immune function was higher than that of positive BALF-GM test (91.8% vs. 89.9%). CONCLUSIONS The results of BALF and serum GM tests are in good agreement with clinical diagnosis, and the combined detection of BALF and serum GM is more valuable for IPA diagnosis than single detection, especially for patients with unknown immune function.
Bronchoalveolar Lavage Fluid/chemistry* ; Galactose/analogs & derivatives* ; Humans ; Invasive Pulmonary Aspergillosis/diagnosis* ; Mannans/blood* ; Sensitivity and Specificity

OBJECTIVEGalactomannan (GM) is a major aspergilli cell-wall constituent released into circulation during the early stage of invasive disease, and can be detected. Many studies suggest that serum galactomannan assay has an excellent sensitivity and specificity for the early diagnosis of adult invasive aspergillosis (IA). However, there have been few studies on serum galactomannan assay in pediatric patients. Therefore, we evaluate the value of serum galactomannan assay in the diagnosis of pediatric invasive pulmonary aspergillosis in this study.

METHODBlood samples were obtained from 88 children, of whom 14 had definitive or possible invasive pulmonary aspergillosis (IPA), 16 had other invasive pulmonary fungal infection and 58 had pulmonary non-fungal infection. Of the 58 patients, 23 had bacterial pneumonia, 20 had mycoplasma pneumonia and 15 had pulmonary tuberculosis. A double-direct sandwich ELISA was employed to detect GM optical density index (ODI) in the serum sample. GM ODI were observed before and after treatment in six children with IPA. Measurement data followed the Gaussian distribution were expressed as x(-) +/- s; differences among groups were tested using a single factor analysis of variance. If the s>1/3 x(-), measurement data were expressed as M [minimum, maximum], and the differences among groups were tested by a rank sum test. P < 0.05 was considered to be statistically significant.

RESULTThe serum GM ODI in IPA group [1.03 (0.16 - 3.73)] was significantly higher than that in the other invasive pulmonary fungal infection group [0.30 (0.04 - 1.28)] and pulmonary non-fungal infection group [0.24 (0.08 - 0.69)] (P < 0.05). If the cut-off GM ODI was set at 0.5, the sensitivity and specificity of the assay for IPA were 71.4% and 91.9% respectively. The accuracy rate for IPA was 88.6%. If the cut-off GM ODI was set at 0.8, the sensitivity, specificity and accuracy rate for IPA were 64.2%, 98.6% and 93.2% respectively. Of 6 children whose GM were observed serially, GM ODI declined consistently with the clinical remission in 3 children. GM ODI raised in 2 children corresponding to clinical exacerbation. Whereas GM ODI elevated paradoxically regardless of clinical remission in the remaining one patient.

CONCLUSIONSerum GM detection was an effective method for the diagnosis of pediatric IPA.

Adolescent ; Child ; Child, Preschool ; Female ; Humans ; Infant ; Invasive Pulmonary Aspergillosis ; blood ; diagnosis ; Male ; Mannans ; blood ; therapeutic use ; Serologic Tests

Degraded guar was prepared by acid with guar as the main material, which was then brought into reaction with chlorosulfonic acid under proper conditions, the sulfonated degraded guar was obtained successfully. The effects of sulfonation conditions on the SO4(2-) content were investigated, and the proper reaction conditions were determined. The results of infrared spectrometry showed that this sulfated derivative is a novel heparin-like polysaccharide. At the same time, the selective removal of low density lipoprotein (LDL) and fibrinogen (Fib) by degraded guar gum sulfate was studied. The experimental results showed that degraded guar gum sulfate is a novel LDL/ Fib purifying agent. When pH= 5.15 and the initial concentration of the degraded guar gum sulfate is 2500 mg/L, the reduction percentages were about 60%-66% for total cholesterol, about 76%-89% for LDL and very low-density lipoproteins (VLDL), and almost 100% for fibrinogen. There were no significant changes regarding the level of high-density lipoproteins and total proteins.
Fibrinogen ; analysis ; isolation & purification ; Galactans ; chemistry ; Hyperlipidemias ; blood ; Lipoproteins, LDL ; blood ; isolation & purification ; Mannans ; chemistry ; Plant Gums ; chemistry ; Sulfates ; chemistry

BACKGROUNDCritically 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.

METHODSIn 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.

RESULTSOne 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).

CONCLUSIONSThe 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.

Aged ; Aged, 80 and over ; Critical Illness ; Female ; Humans ; Invasive Pulmonary Aspergillosis ; blood ; complications ; pathology ; Male ; Mannans ; blood ; Middle Aged ; Prospective Studies ; Pulmonary Disease, Chronic Obstructive ; blood ; etiology ; pathology

OBJECTIVETo evaluate the value of serum galactomannan (GM) detection for diagnosis of invasive aspergillosis (IA) in hematopoietic stem cell transplant recipients.

METHODSThe serum GM concentration in 167 sera from 46 patients was detected by Platelia Aspergillus double-sandwich enzyme linked immunosorbent assay (PADSELISA). According to the diagnostic criteria of invasive fungal infections in China, the diagnostic changes were evaluated, the sensitivity, specificity and predictive values were calculated.

RESULTSThe sensitivity and specificity of the PADSELISA were 81.8% and 93.3% and the positive and negative predictive values were 90.0% and 87.5% respectively. There were 15 positive cases, and 31 negative cases, and the probable IA cases were increased from 11 to 19 after the GM detection. Moreover, the serous level of galactomannan was correlated with the prognosis of the IA.

CONCLUSIONSThe PADSELISA for GM detection is a reliable method for early diagnosis and treatment of IA in hematopoietic stem cell transplant recipients.

Adult ; Aspergillosis ; blood ; diagnosis ; Early Diagnosis ; Enzyme-Linked Immunosorbent Assay ; methods ; Female ; Hematopoietic Stem Cell Transplantation ; Humans ; Male ; Mannans ; blood ; Postoperative Complications ; blood ; diagnosis ; Sensitivity and Specificity

OBJECTIVETo evaluate the diagnostic value of serum galactomannan antigen (GM) and (1→3)-β-D-glucan antigen (BG) assay in invasive fungal infections (IFI) in the patients with hematologic malignancies and the role in monitoring therapeutic response.

METHODSFifty one patients with hematological malignancies met the criteria for inclusion: (1) body temperature above 38°C for 48 hours, (2) failure to respond to broad-spectrum antibiotic treatment, or (3) temperature rose again after the responded drop. Blood samples were collected twice at the first week, then once a week in at least four weeks. The double antibody sandwich enzyme-linked immunosorbent assay (ELISA) and colorimetric assay were used for detecting GM and BG. The positive GM test is defined as two consecutive tests at different time GM value > 0.5 or > 0.8 and the positive G test is defined as BG value > 80 pg/ml. The patients were assigned into four groups as proven, probable, possible, and non-fungal infection respectively, and 21 normal volunteers were as controls.

RESULTSTwo hundred and forty serum samples were collected from 51 patients including 2 of proven IFI, 26 probable IFI, 17 possible IFI and 6 non-fungal infection. The true-positive group including the proven and probable groups, and true negative group was the non-fungal infection group. GM tests were positive in 21 of 28 cases in true positive group, and only one of 6 cases in non-fungal infection. The sensitivity, specificity, positive predictive value and negative predictive value were 75%, 83.3%, 95.5% and 41.7%, respectively. G tests were positive in all 28 cases of the true positive group, and 4 in 6 non-fungal infection cases. The sensitivity, specificity, positive predictive value and negative predictive value were 100%, 33.3%, 87.5% and 100%, respectively. G test is more sensitive than GM test (P = 0.015), but there was no significant difference in specificity of the two tests (P = 0.242). In 19 of 21 patients with GM test positive, anti-fungal treatment was effective, and GM value gradually decreased to negative, two invalid patients were persistent with GM test positive. After two weeks treatment, the average GM value was significantly lower in the effective group than in the ineffective group (P < 0.05). BG values in the responded patients showed a gradual decline similar to that of GM values, but not to negative. The changes of BG value in ineffective group varied with a trend upward. The changes in BG value had no relation with treatment effectiveness.

CONCLUSIONSSerum GM and BG antigens detection provides strong evidence for early diagnosis of IFI. Combination of GM and G tests can improve the diagnostic specificity and reduce the false positive GM test seems superior to G test for monitoring GM and BG values during treatment.

Adult ; Aged ; Aged, 80 and over ; Antigens, Fungal ; blood ; immunology ; Female ; Hematologic Neoplasms ; immunology ; microbiology ; Humans ; Male ; Mannans ; immunology ; Middle Aged ; Mycoses ; blood ; immunology ; Young Adult ; beta-Glucans ; immunology

OBJECTIVETo explore the value of circulating galactomannan (GM) screening for early diagnosis and treatment monitoring of invasive aspergillosis (IA).

METHODSSerum samples from 141 IA patients for the detection of GM by Platelia Aspergillus (Bia-Rad) were collected before and after systematic anti-fungal therapy.

RESULTS(1) An increase in the clinical diagnosis rate of IA was obtained on the result of GM detection. The GM positivity appeared (10+/-4.1) (8-15) d before positive sputum culture, while (12.6+/-5.7) (6-22) d before the CT positive image. (2) Among the 62 patients with consecutive serum samples, 50 were success in treatment and 12 died. A progressive decrease of GM level was found in the former group, while the rising antigen titres were found in the latter.

CONCLUSIONCompared with other diagnostic test, GM test has an obvious advantage of higher positivity and earlier result. The anti-fungal effectiveness can be estimated by dynamic detection of serum GM.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Aspergillosis ; blood ; diagnosis ; Early Diagnosis ; Enzyme-Linked Immunosorbent Assay ; Female ; Humans ; Male ; Mannans ; blood ; Middle Aged ; Young Adult

OBJECTIVETo explore the relationship between the optical density index of serum aspergillus galactomannan (GM) assay and invasive aspergillosis (IA).

METHODSFrom Jan 2008 to Dec 2011, 825 hematological diseases patients with neutrophil count <0.5×10⁹/L⁹ by continuous blood count tests were admitted into our hospital. The optical density index of GM assay was ≥0.5 at least once. Of 825 patients, 247 cases were manifested as fever during hospitalization. The optical density index of GM antigen was detected by enzyme-linked immunosorbent assay, and the sensitivity and specificity of optical density ranged in 0.5-1.5.

RESULTSIn this study, the sensitivity and specificity of GM assay with continuous twice samples (73% and 93%, respectively) were higher than single sample (66% and 80%, respectively) when optical density index ≥1.0. 69 cases were diagnosed as proven IA with the incidence rate of 8.36%.

CONCLUSIONThe cut-off level for serum GM antigen assay should be decided as optical density index in two continuous samples of ≥1.0.

Adolescent ; Adult ; Aged ; Antigens, Fungal ; blood ; Aspergillosis ; blood ; diagnosis ; etiology ; Enzyme-Linked Immunosorbent Assay ; Female ; Hematologic Diseases ; blood ; microbiology ; Humans ; Male ; Mannans ; blood ; immunology ; Middle Aged ; Sensitivity and Specificity ; Young Adult

OBJECTIVETo evaluate serum antigens assay combined with chest CT scan in the diagnosis of patients of invasive pulmonary aspergillosis (IPA) without neutropenia.

METHODSOne hundred and thirteen patients with suspected IPA admitted in Department of Respiratory Medicine, Infectious Diseased, Kidney Disease Centre and ICU were included in the study. Serum levels of 1-3-β-D-glucan (G) antigen and galactomannan antigen (GM) were assayed and chest CT scans were performed in all cases. Clinically invasive pulmonary aspergillosis was defined as proven, probable and possible. Treatment effectiveness was recorded.

RESULTSIn this series 4 proven IPA, 36 probable IPA, 16 possible IPA, and 57 non-aspergillosis infection were diagnosed. GM test was more sensitive than G test. The specificity of two serum test was 84.2% and 87.7%, respectively. The sensitivity of chest CT was 30.0 %. The specificity of GM assay combined with chest CT was 100.0 %, while the sensitivity was 47.5%.

CONCLUSIONThe GM assay combined with chest CT may increase the specificity of diagnosis for IPA patients without neutropenia.

Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Invasive Pulmonary Aspergillosis ; blood ; diagnosis ; diagnostic imaging ; Male ; Mannans ; blood ; Middle Aged ; Sensitivity and Specificity ; Tomography, X-Ray Computed ; Young Adult ; beta-Glucans ; blood