Document Detail


Post-diagnostic kinetics of the (1 → 3)-β-D-glucan assay in invasive aspergillosis, invasive candidiasis and Pneumocystis jirovecii pneumonia.
MedLine Citation:
PMID:  22404638     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The kinetics of serum (1 → 3)-β-d-glucan (BG) following the diagnosis of invasive fungal disease and administration of antifungal therapy are poorly characterized. It is unknown whether early BG changes have prognostic implications. We assessed the post-diagnostic kinetics of BG in patients with an initial serum BG ≥80 pg/mL and at least one additional post-diagnostic BG value in the setting of invasive aspergillosis (IA, n=69), invasive candidiasis (IC, n=40), or Pneumocystis jirovecii pneumonia (PCP, n = 18), treated with antifungal therapy. Clinical failure of antifungal therapy and mortality were assessed at 6 and 12 weeks, and Cox modelling was used to assess the hazard of initial BG and change in BG at 1 or 2 weeks for these outcomes. In patients with at least two BG values, median initial BG was >500 pg/mL (interquartile range (IQR) 168 to >500; range 80 to >500) in IA, 136 pg/mL (IQR 88 to >500; range 31 to >500) in IC and >500 pg/mL (IQR 235 to >500; range 86 to >500) in PCP. In patients with at least two BG values through to 1 week after diagnosis, overall 1-week decline in BG was 0 pg/mL (IQR 0-53) in IA, 0 (IQR - 65 to 12) in IC and 17 (IQR 0-82) in PCP. Most patients with BG values through 6 and 12 weeks had persistent levels >80 pg/mL. Initial BG and the early trajectory of BG were not predictive of 6-week or 12-week clinical failure or mortality. Whereas BG eventually declines in patients with IA, IC and PCP, it lacks prognostic value within a clinically meaningful time frame.
Authors:
S Koo; L R Baden; F M Marty
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2012-03-08
Journal Detail:
Title:  Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases     Volume:  18     ISSN:  1469-0691     ISO Abbreviation:  Clin. Microbiol. Infect.     Publication Date:  2012 May 
Date Detail:
Created Date:  2012-04-17     Completed Date:  2012-08-06     Revised Date:  2013-06-26    
Medline Journal Info:
Nlm Unique ID:  9516420     Medline TA:  Clin Microbiol Infect     Country:  France    
Other Details:
Languages:  eng     Pagination:  E122-7     Citation Subset:  IM    
Copyright Information:
© 2012 The Authors. Clinical Microbiology and Infection © 2012 European Society of Clinical Microbiology and Infectious Diseases.
Affiliation:
Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA. skoo@partners.org
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Antifungal Agents / therapeutic use*
Antigens, Fungal / blood
Aspergillosis / diagnosis*,  drug therapy,  microbiology,  mortality
Aspergillus / classification,  drug effects
Candida / classification,  drug effects
Candidiasis, Invasive / diagnosis*,  drug therapy,  microbiology,  mortality
Cause of Death
Female
Humans
Kinetics
Male
Middle Aged
Pneumocystis jirovecii / drug effects
Pneumonia, Pneumocystis / diagnosis*,  drug therapy,  microbiology,  mortality
Prognosis
Treatment Failure
Young Adult
beta-Glucans / blood*
Grant Support
ID/Acronym/Agency:
UL1 RR 025758/RR/NCRR NIH HHS; UL1 RR025758/RR/NCRR NIH HHS; UL1 RR025758-01/RR/NCRR NIH HHS
Chemical
Reg. No./Substance:
0/Antifungal Agents; 0/Antigens, Fungal; 0/beta-1,3-D-glucan; 0/beta-Glucans
Comments/Corrections

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