1,3-Beta-D-glucan antigenemia for early diagnosis of invasive fungal infections in neutropenic patients with acute leukemia.
BACKGROUND
Invasive fungal infections (IFIs) are life-threatening complications in neutropenic patients with hematological malignancies. Because early diagnosis of IFI is difficult, new noninvasive, culture-independent diagnostic tools are needed to improve clinical management. Recent studies have reported that detection of 1,3-beta-D-glucan (BG) antigenemia may be useful for diagnosis of IFI. The aim of the present prospective study was to evaluate the usefulness of monitoring BG in patients undergoing chemotherapy for acute leukemia.


METHODS
BG antigenemia was measured by a colorimetric assay twice weekly in the absence of fever and daily in the presence of fever. IFIs were classified according to the criteria of the European Organization for Research and Treatment of Cancer/Mycoses Study Group.


RESULTS
During 190 consecutive neutropenic episodes (median duration, 22 days; range, 7-113 days) in 95 patients, 30 proven or probable IFIs (13 aspergillosis, 15 candidiasis, and 2 mixed IFIs) were diagnosed. Sensitivity, specificity, positive predictive value, negative predictive value, and efficiency of 2 consecutive BG values > or =7 pg/mL for diagnosis of proven or probable IFI was 0.63 (95% confidence interval, 0.44-0.79), 0.96 (95% confidence interval, 0.89-0.98), 0.79 (95% confidence interval, 0.57-0.92), 0.91 (95% confidence interval, 0.84-0.95), and 0.89, respectively. The time interval between onset of fever as first sign of IFI and BG antigenemia was significantly shorter than the time to diagnosis of IFI by clinical, microbiological, radiological, and/or histopathological criteria (P < .001). BG values >50 pg/mL were observed in only 2 patients, both of whom experienced failure of antifungal therapy.


CONCLUSIONS
Monitoring of BG antigenemia is a useful noninvasive method for early diagnosis of IFI in patients with acute leukemia.
Senn
Laurence
L
Infectious Diseases Service, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland.
Robinson
James Owen
JO
Schmidt
Sabine
S
Knaup
Marlies
M
Asahi
Nobuo
N
Satomura
Shinji
S
Matsuura
Shuuji
S
Duvoisin
Bertrand
B
Bille
Jacques
J
Calandra
Thierry
T
Marchetti
Oscar
O
D000328:Adult; D000368:Aged; D000946:Antigens, Fungal / Q000097:blood*; D001228:Aspergillosis / Q000175:diagnosis; D002177:Candidiasis / Q000175:diagnosis; D005260:Female; D016469:Fungemia / Q000175:diagnosis*; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000150:complications*; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000175:diagnosis*; D009503:Neutropenia / Q000150:complications*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications*; D011237:Predictive Value of Tests; D011509:Proteoglycans; D012680:Sensitivity and Specificity; D047071:beta-Glucans / Q000097:blood*
D000946:Antigens, Fungal; D011509:Proteoglycans; D047071:beta-Glucans; C010770:polysaccharide-K