Serum Glucan Levels Are Not Specific for Presence of Fungal Infections in Intensive Care Unit Patients

Abstract

Fungal infections in the critically ill patient are difficult to diagnose and are associated with a high mortality rate. A major obstacle to managing fungal infection is the lack of a reliable clinical assay that will rapidly identify patients with fungal sepsis. Glucans are polymers of glucose that are found in the cell wall of fungi and certain bacteria. Glucans are also released from the fungal cell wall into the extracellular milieu. Several studies have reported that detection of fungal glucan in serum or plasma is useful in the diagnosis of mycoses. However, recent studies have questioned the clinical utility of this assay. In this study, we examined serum glucan levels in intensive care unit (ICU) patients and attempt to correlate serum glucan levels with the presence of fungal infection. Following attainment of informed consent, serum was harvested from 46 ICU patients with confirmed fungal infections, confirmed bacterial infections, or no evidence of infection. Sera from eight healthy volunteers served as control. Serum glucan was assayed with a glucan-specific Limulus assay. Serum glucan levels were increased (69.6 ؎ 17 pg/ml; P < 0.001) in ICU patients versus the normal (11.5 ؎ 1.3 pg/ml) and noninfected ICU (27.4 ؎ 17 pg/ml) controls. However, serum glucan levels were not different in patients with confirmed fungal infections versus those with confirmed bacterial infections. Thus, serum glucan levels did not show a correlation with the presence of fungal infections and do not appear to be specific for fungal infections. However, the assay may be useful as a negative predictor of infection.

Value of β-d-glucan and Candida albicans germ tube antibody for discriminating between Candida colonization and invasive candidiasis in patients with severe abdominal conditions

“…This finding is clinically relevant not only for the population to which the prediction rule can be applied, but also because it is very easy to remember and may help intensivists to decide when to start antifungal treatment. A few studies have investigated the predictive value of BDG on IC in non-neutropenic critically ill patients [21][22][23][24][25]. Elevated concentrations of BDG have been reported to be associated with other fungi, such as Pneumocystis jirovecii infections [26], Gram-positive and Gram-negative bloodstream infections, exposure to gauze or other materials that contain glucans, biofilms on vascular catheters, hemodialysis, and administration of a,b Superscripts indicate significant differences (P \ 0.05) among rates of BDG and positive CAGTA values among the three study groups Fig.…”

“…The reason for ICU admission was medical in 18.8 % of patients, surgical in 76.1 %, and trauma in 5.1 %. The median (IQR) length of ICU and hospital stay was 15 (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27) and 38 (24-57) days, respectively, which were significantly higher in patients with IC compared to the other two groups. ICU and hospital crude mortality rates were 26.7 and 32.4 %, respectively.…”

Diagnostic potential of nested PCR, galactomannan EIA, and Beta-D-glucan for invasive aspergillosis in pediatric patients

“…The present results showed that the BDG test is not specific in pediatric febrile neutropenia. Digby et al also reported that the BDG test is not specific in febrile neutropenia patients admitted to the ICU [30].…”

“…Furthermore, some conditions such as exposure to certain gauzes [25], taking several antibiotics at high concentrations [26], using certain hemodialysis cellulose membranes [27], and receipt of albumin or immunoglobulin products, plasma proteins or coagulation factors [28] may contribute to a greater yield of false positive. False positives by BDG may also be obtained by a variety of other reasons including "bacteremia, hemolysis; intravenous administration of treatment with certain medications; exposure to cotton bandages; heat stroke; and unknown causes" [29,30]. The use of different species of horseshoe crab as a source of reagent by the manufacturers creates different cutoff values.…”

Role of Flexible-Bronchoscopy in Pulmonary and Critical Care Practice

“…Newer techniques like BAL galactomannan levels which have a good sensitivity and specificity for the detection of invasive disease could be promising for the diagnosis (Meersseman et al,2008;Hsu et al, 2010;Maertens et al, 2009); however, false-positive results are seen. (Digby et al, 2003) Candida is a frequent colonizer and their presence in BAL fluid may represent colonization rather than infection in the immunocompetent host. (el-Ebiary et al,1997) In patients with non-resolving pneumonias in endemic areas, morphological and cytological analysis may aid in therapy of endemic mycoses like histoplasmosis, blastomycosis, coccidioidomycosis and paracoccidioidomycosis; however culture is diagnostic.…”