| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
1 Department of Medicine, Faculty of Medicine and Health Sciences, UAE University, Al-Ain, UAE
2 Department of Medical Microbiology, Faculty of Medicine and Health Sciences, UAE University, Al-Ain, UAE
3 Associates of Cape Cod, Falmouth, MA, USA
4 Department of Medicine, Al-Ain Hospital, Al-Ain, UAE
5 Department of Oncology, Tawam-Hopkins Hospital, Al-Ain, UAE
6 Department of Clinical Bacteriology, Karolinska University Hospital, Stockholm, Sweden
Correspondence
Michael Ellis
michael.ellis{at}uaeu.ac.ae
Received 27 June 2007
Accepted 13 November 2007
2 sequential concentrations of 80 pg ml–1 (‘positive’ test) was found to give the best overall option for diagnosis, with an accuracy of 81.3 %, sensitivity of 86.8 %, positive predictive value of 76.7 % and negative predictive value of 86.5 %. Of the patients with an IFI, 78 % developed a positive test at or before the clinical diagnosis was made – this occurred at a mean (range) of 1.25 (–14 to +14) days prior to the IFI diagnosis. By starting sampling of blood from the first day of neutropenia rather than from the first day of AUNF, 50 % of the patients with subsequent IFI would have been identified 5 days earlier. Increasing sampling to daily from alternate-day frequency did not further improve this earlier timing of an IFI diagnosis. A greater proportion of patients with persistent high levels of BG without overt IFI had severe enterocyte damage or mucositis than those with lower levels of BG without IFI (P=0.002). If the results of the initial BG test had been acted on to change antifungal therapy, discontinuation would have been inappropriate in 30 % of patients and would have delayed definitive antifungal therapy. Although the findings for the cohort of patients studied are very useful, there is inter-patient variability in the test's performance. An holistic diagnostic approach is therefore necessary to interpret the test results optimally. Future studies should address this in further detail as well as the impact of empirical antifungal drug use and patient outcome.
Abbreviations: AUNF, antibiotic-unresponsive neutropenic fever; BG, β-D-glucan; HRCT, high-resolution computed tomography; IFI, invasive fungal infection; IPA, invasive pulmonary aspergillosis; NPV, negative predictive value; PPV, positive predictive value.
Supplementary data are available with the online version of this paper.
This article has been cited by other articles:
|
|
 |
|
  M. Ellis, R. Bernsen, H. Ali-Zadeh, J. Kristensen, U. Hedstrom, L. Poughias, M. Bresnik, A. Al-Essa, and D. A. Stevens A safety and feasibility study comparing an intermittent high dose with a daily standard dose of liposomal amphotericin B for persistent neutropenic fever J. Med. Microbiol., November 1, 2009; 58(11): 1474 - 1485. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Ellis, B. Al-Ramadi, R. Bernsen, J. Kristensen, H. Alizadeh, and U. Hedstrom Prospective evaluation of mannan and anti-mannan antibodies for diagnosis of invasive Candida infections in patients with neutropenic fever J. Med. Microbiol., May 1, 2009; 58(5): 606 - 615. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Y. Hachem, D. P. Kontoyiannis, R. F. Chemaly, Y. Jiang, R. Reitzel, and I. Raad Utility of Galactomannan Enzyme Immunoassay and (1,3) {beta}-D-Glucan in Diagnosis of Invasive Fungal Infections: Low Sensitivity for Aspergillus fumigatus Infection in Hematologic Malignancy Patients J. Clin. Microbiol., January 1, 2009; 47(1): 129 - 133. [Abstract] [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| INT J SYST EVOL MICROBIOL | J MED MICROBIOL | MICROBIOLOGY | J GEN VIROL | ALL SGM JOURNALS |
