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首页> 美国卫生研究院文献>Journal of Clinical Microbiology >(13)-β-d-Glucan in Cerebrospinal Fluid for Diagnosis of Fungal Meningitis Associated with Contaminated Methylprednisolone Injections
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(13)-β-d-Glucan in Cerebrospinal Fluid for Diagnosis of Fungal Meningitis Associated with Contaminated Methylprednisolone Injections

机译：脑脊液中的（13）-β-d-葡聚糖可用于诊断与甲基强的松龙注射液污染相关的真菌性脑膜炎

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Prompt diagnosis and treatment of fungal meningitis are critical, but culture is insensitive. (1,3)-β-d-Glucan (BDG) testing is FDA approved for serological diagnosis of invasive fungal disease; however, BDG testing is not approved for cerebrospinal fluid (CSF), and the appropriate cutoff value is unknown. We aimed to validate the diagnostic accuracy of CSF BDG measurements for fungal meningitis among patients exposed to contaminated methylprednisolone acetate (MPA). A retrospective observational study was conducted at St. Joseph Mercy Hospital and Vanderbilt University from November 2013 to February 2014. Patients were included if they had received a contaminated MPA injection. Cases were classified as probable or proven meningitis according to Centers for Disease Control and Prevention guidelines. CSF BDG testing was performed according to the package insert instructions for serum samples, and results were validated using Clinical and Laboratory Standards Institute procedures (MiraVista Diagnostics). Of 233 patients, 45 had meningitis (28 proven cases), 53 had spinal/paraspinal infections (19 proven cases), and 135 did not develop disease. Using the manufacturer's cutoff value (≥80 pg/ml), the sensitivity and specificity were 96% and 95%, respectively, for proven meningitis and 84% and 95% for probable or proven meningitis. Receiver operating characteristic analysis identified the optimal cutoff value for proven meningitis to be 66 pg/ml (sensitivity, 100%; specificity, 94%) and that for probable or proven meningitis to be 66 pg/ml (sensitivity, 91%; specificity, 92%). Our results suggest that CSF BDG measurements are highly sensitive and specific for the diagnosis of fungal meningitis associated with contaminated MPA injections. Further study on the utility of CSF BDG testing for other types of fungal meningitis is needed.
机译：及时诊断和治疗真菌性脑膜炎至关重要，但培养不敏感。 （1,3）-β-d-葡聚糖（BDG）测试已获得FDA批准，可用于侵袭性真菌疾病的血清学诊断；但是，尚未批准对脑脊液（CSF）进行BDG测试，并且尚不清楚适当的临界值。我们旨在验证暴露于受污染的甲基强的松龙（MPA）患者中真菌性脑膜炎的脑脊液BDG测量的诊断准确性。回顾性观察研究于2013年11月至2014年2月在圣约瑟夫·梅西医院和范德比尔特大学进行。如果患者接受了MPA注射污染，则将其包括在内。根据美国疾病控制和预防中心指南，将病例归为可能或已证实的脑膜炎。根据血清样本的包装说明书进行CSF BDG测试，并使用临床和实验室标准协会的程序（MiraVista Diagnostics）验证结果。在233例患者中，有45例患有脑膜炎（已确诊28例），有53例患有脊髓/脊柱旁感染（已证实19例），还有135例未患病。使用制造商的临界值（≥80pg / ml），对于证实为脑膜炎的敏感性和特异性分别为96％和95％，对于可能或证实为脑膜炎的敏感性和特异性分别为84％和95％。接收者操作特征分析确定，对于已证实的脑膜炎，最佳临界值是66 pg / ml（敏感性，100％；特异性，94％），对于可能或已证实的脑膜炎，最佳临界值是66 pg / ml（敏感性，91％；特异性， 92％）。我们的结果表明，脑脊液BDG的测量对与MPA注射污染有关的真菌性脑膜炎的诊断具有高度的敏感性和特异性。需要对CSF BDG检测对其他类型的真菌性脑膜炎的实用性进行进一步研究。

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