Abstract:Invasive fungal diseases are associated with significant morbidity and mortality, particularly in immunocompromised individuals. Early and accurate diagnosis is crucial for effective treatment. Despite traditional methods such as microbiological culture, histopathology, radiology and direct microscopy are available, antigen/antibody‐based diagnostics are emerging for diagnosis of invasive fungal infections (IFI). Fungal cell wall is a unique structure composed of polysaccharides that are well correlated with f… Show more
“…Over the last four decades, increasing numbers of fungal biomarkers have been added to the roster of tests available as aids to the diagnosis of invasive fungal disease (IFD) [1][2][3]. Among these is (1→3)-β-glucan, a cell wall component of almost all pathogenic fungi, with the exception of the Mucorales [4,5]. At this point, analysis of circulating titers of (1→3)-β-D-glucan (BDG) has been practiced for almost three decades, as an adjunct to the diagnosis of IFD [6].…”
(1→3)-β-glucan (BDG) testing as an adjunct in the diagnosis of invasive fungal disease (IFD) has been in use for nearly three decades. While BDG has a very high negative predictive value in this setting, diagnostic false positives may occur, limiting specificity and positive predictive value. Although results may be diagnostically false positive, they are analytically correct, due to the presence of BDG in the circulation. This review surveys the non-IFD causes of elevated circulating BDG. These are in the main, iatrogenic patient contamination through the use of BDG-containing medical devices and parenterally-delivered materials as well as translocation of intestinal luminal BDG due to mucosal barrier injury. Additionally, infection with Nocardia sp. may also contribute to elevated circulating BDG. Knowledge of the factors which may contribute to such non-IFD-related test results can improve the planning and interpretation of BDG assays and permit investigational strategies, such as serial sampling and BDG clearance evaluation, to assess the likelihood of contamination and improve patient care.
“…Over the last four decades, increasing numbers of fungal biomarkers have been added to the roster of tests available as aids to the diagnosis of invasive fungal disease (IFD) [1][2][3]. Among these is (1→3)-β-glucan, a cell wall component of almost all pathogenic fungi, with the exception of the Mucorales [4,5]. At this point, analysis of circulating titers of (1→3)-β-D-glucan (BDG) has been practiced for almost three decades, as an adjunct to the diagnosis of IFD [6].…”
(1→3)-β-glucan (BDG) testing as an adjunct in the diagnosis of invasive fungal disease (IFD) has been in use for nearly three decades. While BDG has a very high negative predictive value in this setting, diagnostic false positives may occur, limiting specificity and positive predictive value. Although results may be diagnostically false positive, they are analytically correct, due to the presence of BDG in the circulation. This review surveys the non-IFD causes of elevated circulating BDG. These are in the main, iatrogenic patient contamination through the use of BDG-containing medical devices and parenterally-delivered materials as well as translocation of intestinal luminal BDG due to mucosal barrier injury. Additionally, infection with Nocardia sp. may also contribute to elevated circulating BDG. Knowledge of the factors which may contribute to such non-IFD-related test results can improve the planning and interpretation of BDG assays and permit investigational strategies, such as serial sampling and BDG clearance evaluation, to assess the likelihood of contamination and improve patient care.
“…The initial suspicion of IMI was based on a positive GM serology. The GM ELISA is an Aspergillus-specific test known for its high specificity and almost negligible cross reactivity to other fungal pathogens [31]. However, the close phylogenetic relationship of the genera Talaromyces and Aspergillus might be an explanation for this finding [24].…”
Background
Increasing incidence of invasive infections caused by rare fungi was observed over the recent years.
Case
Here, we describe the first reported case of an infection caused by the thermophilic mold Talaromyces thermophilus. Cultivation and, hence, identification of this fastidious organism is challenging since standard incubation conditions are not sufficient. Retrospective analysis of patient samples and in vitro experiments demonstrated that testing for fungal antigens, i.e., the cell wall components galactomannan and β-1,3-d-glucan, is a promising tool.
“…1 They can be also overexpressed by cancer cells 2 or used as markers of some infection diseases. 3 To decipher the complex biological and physicochemical properties of this family of biomolecules, analytical strategies are still being developed. 4 Very recently, low-temperature scanning tunneling microscopy allowed direct imaging of different conformers of some oligosaccharides with a subnanometer resolution.…”
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