Amalia del Palacio

Contribution of (1→3)-β-d-Glucan Chromogenic Assay to Diagnosis and Therapeutic Monitoring of Invasive Aspergillosis in Neutropenic Adult Patients: a Comparison with Serial Screening for Circulating Galactomannan

ABSTRACT Two noninvasive diagnostic tests, (1→3)-β-d-glucan (BG) (Glucatell) and galactomannan (GM) (Platelia Aspergillus), were used retrospectively in a twice-weekly screening for the diagnosis of invasive aspergillosis (IA) in 40 treatment episodes (one hospital visit per patient) in 40 neutropenic adult patients at high risk for IA. Five proven IA cases, three probable IA cases, and three possible IA cases were diagnosed. Diagnostic levels of both BG and GM were detected in 100% of patients with proven IA cases and in 66% of patients with probable IA cases. The kinetics of both markers in patients with IA were similar. The sensitivity, specificity, and positive and negative predictive values for GM and BG were identical, namely, 87.5, 89.6, 70, and 96.3%, respectively. False-positive reactions occurred at a rate of 10.3% in both tests, but the patients showing false-positive results were different in each test. Both tests anticipated the clinical diagnosis, computed tomography abnormalities, and the initiation of antifungal therapy in most patients, but BG tended to become positive earlier than GM. A combination of the two tests improved the specificity (to 100%) and positive predictive value (to 100%) of each individual test without affecting the sensitivity and negative predictive values. In conclusion, BG and GM detection are useful tests for the diagnosis of IA in high-risk hematological patients, but a combination of the two tests was very useful to identify false-positive reactions by each test.

ITRACONAZOLE VERSUS GRISEOFULVIN IN THE TREATMENT OF TINEA CAPITIS: A DOUBLE‐BLIND RANDOMIZED STUDY IN CHILDREN

Background. Tinea capitis is a fungal infection in which topical therapy is often unsuccessful. Griseofulvin has been considered to be a first‐line therapy. Other antifungal agents are the azole derivatives. Among these, itraconazole was compared with griseofulvin in children in a double‐blind study.

Utilidad de la detección de (1→3)-ß-D-glucano y anticuerpos anti-micelio de Candida albicans para el diagnóstico y seguimiento terapéutico de la candidiasis invasora en pacientes neutropénicos adultos

Resumen Se ha evaluado la utilidad de la deteccion dos veces por semana de s-glucano (BG) y de anticuerpos anti-micelio de Candida albicans (CAGT) para el diagnostico y el seguimiento de la candidiasis invasora (CI) en 35 episodios de pacientes neutropenicos de alto riesgo. Se diagnosticaron tres casos de CI probada y tres probables. Se alcanzaron resultados positivos para ambos marcadores en el 100% de las CI probadas y en el 66% de las CI probables. La sensibilidad, especificidad, valores predictivos positivo y negativo para la deteccion de BG y anticuerpos contra CAGT fueron 83,3%, 89,6%, 62,5% y 96,3%, y 83,3%, 86,2%, 55,5% y 96,1%, respectivamente. El porcentaje de falsos positivos para BG y anticuerpos contra CAGT fue del 10,3% y 13,8% para la deteccion de BG y anticuerpos anti-CAGT, respectivamente. Sin embargo, los pacientes con resultados falsos positivos fueron diferentes para cada prueba. Ambas pruebas se anticiparon al diagnostico clinico y radiologico, asi como al inicio de la terapia antifungica en la mayoria de los pacientes. La combinacion de ambas pruebas mejoro la especificidad y el valor predictivo positivo hasta el 100%.

In Vitro Susceptibilities of Malassezia Species to a New Triazole, Albaconazole (UR-9825), and Other Antifungal Compounds

ABSTRACT The in vitro activity of the new triazole albaconazole (UR-9825) in comparison with those of flucytosine, fluconazole, ketoconazole, itraconazole, and voriconazole against 70 strains of Malassezia spp. was determined by a microdilution method using a colorimetric indicator for metabolic activity. Albaconazole showed an in vitro profile similar to those of the different antifungals tested (MIC ≤ 0.06 μg/ml for all the strains).

Successful treatment of mucor infection after liver or pancreas-kidney transplantation.

BACKGROUND Mucormycosis is a rare and opportunistic infection usually associated with hematologic diseases, diabetes mellitus, renal failure, solid tumors, and organ transplantation. METHODS We present five cases of mucor infection after transplantation (three after a series of 750 orthotopic liver transplantation and two after a series of 13 simultaneous pancreas-kidney transplantation in patients with type 1 diabetes) subjected to medical and surgical treatment and analyze the factors related to the development of this infection. RESULTS The clinical forms were two cutaneous (laparotomy wound or prior surgical drain site), two rhino-maxillary, and one pulmonary. As risk factors for mucormycosis all patients had pre- or posttransplantation diabetes, and showed at least one episode of acute rejection that required aggressive immunosuppression (2-7 g of methylprednisolone; also three patients were treated with antithymocyte globulin [ATG] monoclonal antibody [orthoclone and/or OKT3]). We also found renal failure, acidosis, malnutrition, and Candida and cytomegalovirus infections as factors related to mucor infection. Diagnosis of fungal infection was confirmed by exudate or fluid culture in three cases and by biopsy in two. All patients were treated with liposomal amphotericin B (from 3.5 to 5.6 g of total dose) and resection until the surgical margins were free of infection. All patients survived after this severe infection. CONCLUSIONS With an early diagnosis of mucormycosis by clinical findings, culture, or tissue biopsy, and aggressive treatment consisting of administration of liposomal amphotericin B and surgical resection of all infected tissue, excellent results are achieved.

Detection of (1 → 3)-β-D-glucan as an adjunct to diagnosis in a mixed population with uncommon proven invasive fungal diseases or with an unusual clinical presentation.

ABSTRACT This single-center observational prospective study evaluated the performance of (1→3)-β-d-glucan as an adjunct diagnostic tool in 12 patients with proven invasive fungal disease with different risk factors. The infections were due to either uncommon fungal pathogens such as dematiaceous molds (Scedosporium apiospermum, Alternaria infectoria, and Cladosporium macrocarpum) and hyaline septate molds (Fusarium solani and Blastoschizomyces capitatus) or Aspergillus spp. with unusual clinical presentations.

Diagnosis of invasive candidiasis by enzyme-linked immunosorbent assay using the N-terminal fragment of Candida albicans hyphal wall protein 1

BackgroundThe diagnosis of invasive candidiasis is difficult because there are no specific clinical manifestations of the disease and colonization and infection are difficult to distinguish. In the last decade, much effort has been made to develop reliable tests for rapid diagnosis of invasive candidiasis, but none of them have found widespread clinical use.ResultsAntibodies against a recombinant N-terminal fragment of the Candida albicans germ tube-specific antigen hyphal wall protein 1 (Hwp1) generated in Escherichia coli were detected by both immunoblotting and ELISA tests in a group of 36 hematological or Intensive Care Unit patients with invasive candidiasis and in a group of 45 control patients at high risk for the mycosis who did not have clinical or microbiological data to document invasive candidiasis. Results were compared with an immunofluorescence test to detect antibodies to C. albicans germ tubes (CAGT). The sensitivity, specificity, positive and negative predictive values of a diagnostic test based on the detection of antibodies against the N-terminal fragment of Hwp1 by immunoblotting were 27.8 %, 95.6 %, 83.3 % and 62.3 %, respectively. Detection of antibodies to the N-terminal fragment of Hwp1 by ELISA increased the sensitivity (88.9 %) and the negative predictive value (90.2 %) but slightly decreased the specificity (82.6 %) and positive predictive values (80 %). The kinetics of antibody response to the N-terminal fragment of Hwp1 by ELISA was very similar to that observed by detecting antibodies to CAGT.ConclusionAn ELISA test to detect antibodies against a recombinant N-terminal fragment of the C. albicans germ tube cell wall antigen Hwp1 allows the diagnosis of invasive candidiasis with similar results to those obtained by detecting antibodies to CAGT but without the need of treating the sera to adsorb the antibodies against the cell wall surface of the blastospore.

Evaluation of a Novel Enzyme-Linked Immunosorbent Assay To Detect Immunoglobulin G Antibody to Enolase for Serodiagnosis of Invasive Candidiasis

ABSTRACT The performance of a new test to detect antibodies to Candida albicans recombinant enolase was investigated in 47 immunocompromised and 51 immunocompetent patients. The sensitivity, specificity, and positive and negative predictive values of the test for the diagnosis of invasive candidiasis were 81.0, 83.9, 79.1, and 85.5%, respectively.

Avances y limitaciones del diagnóstico precoz de las infecciones invasoras causadas por levaduras

Resumen En los ultimos anos los principales avances en el diagnostico serologico de las micosis por hongos levaduriformes se han producido en el campo de la deteccion de anticuerpos y de (1-3)-s-D-glucano. La comercializacion de la prueba Candida albicans IFA IgG y la deteccion de anticuerpos frente a los antigenos recombinantes Hwp1 y enolasa son las aportaciones mas importantes en el primero de los campos. La deteccion de (1-3)-s-D-glucano se confirma como un buen marcador para el diagnostico de la candidiasis invasora. Los estudios mas recientes sugieren que sera necesaria la combinacion de dos tecnicas que detecten antigeno, anticuerpos, (1-3)-s-D-glucano y ADN para optimizar el diagnostico de las infecciones sistemicas por levaduras.

Epidemiología de las candidiasis invasoras en población pediátrica y adulta

BACKGROUND Invasive candidiasis (IC) is the most frequent fungal disease in children and adults. AIMS To critically review and update the current epidemiology of Candida spp. disease in neonates, children and adults (critically ill patients and in oncohematologic patients and in solid organ transplant recipients). METHODS We searched the PubMed/Medline, discussing the current data. RESULTS AND CONCLUSIONS IC is associated with high attributable morbimortality and increased healthcare costs. In the last decades the incidence of invasive Candida spp. disease has increased in critically ill patients, has decreased in oncohematologic patients, although currently the involvement of non-albicans Candida species in the etiology of this disease is increasing steadily.Resumen Antecedentes La candidiasis invasora (CI) es la enfermedad fungica oportunista mas frecuente, tanto en ninos como en adultos. Objetivos Se presenta una revision actualizada sobre los aspectos epidemiologicos en neonatos, ninos y adultos ingresados en unidades de cuidados intensivos, asi como en pacientes oncohematologicos y receptores de trasplantes de organo solido. Metodos Se ha realizado una busqueda bibliografica en la base de datos PubMed/Medline. Se presenta una revision actualizada. Resultados y conclusiones La CI se asocia a una elevada morbimortalidad y costes economicos. En las ultimas decadas, la enfermedad invasora debida a Candida spp. ha aumentado de forma significativa en pacientes criticos, ha disminuido en pacientes oncohematologicos, aunque en todas las distintas subpoblaciones son mas prevalentes las especies de Candida diferentes de C. albicans.