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首页> 外文期刊>Journal of Clinical Microbiology >Point-Counterpoint: β-d-Glucan Testing Is Important for Diagnosis of Invasive Fungal Infections
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Point-Counterpoint: β-d-Glucan Testing Is Important for Diagnosis of Invasive Fungal Infections

机译：点对点：β-d-葡聚糖检测对侵袭性真菌感染的诊断很重要

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Invasive fungal infections are a significant cause of morbidity and mortality in patients who receive immunosuppressive therapy, such as solid organ and hematopoietic stem cell transplant (HSCT) recipients. Many of the fungi associated with these infections are angioinvasive and are best diagnosed by visualizing the organism in or culturing the organism from deep tissue. However, obtaining such tissue often requires an invasive procedure. Many HSCT recipients are thrombocytopenic, making such procedure too risky because of potential bleeding complications. Additionally, positive blood cultures are rare for patients with angioinvasive fungal infections, making this diagnostic strategy of little value. Undiagnosed fungal infections in these patient populations are a significant cause of mortality. Prophylactic use of antifungal agents, such as the echinocandins, during periods of neutropenia or graft-versus-host disease may prevent some fungal infections but increase the risk for others. Detection of fungal antigens in body fluids, including cryptococcus capsular polysaccharide, histoplasma antigen, galactomannan, and β-d-glucan, is viewed as being clinically useful for at least the presumptive diagnosis of invasive fungal infections. β-d-Glucan is an attractive antigen in that it is found in a broad range of fungal agents, including the commonly encountered agents Candida spp., Aspergillus spp., and Pneumocystis jirovecii. Cross-reactions with certain hemodialysis filters, beta-lactam antimicrobials, and immunoglobulins, which raise concerns about false-positive tests, have also been described. As a result, the use of this testing must be closely monitored. In this point-counterpoint, we have asked Elitza Theel, who directs the Infectious Disease Serology Laboratory at the Mayo Clinic, to address why she believes that this test has value in the diagnosis of invasive fungal infections. We have asked Christopher Doern, Director of Clinical Microbiology at Children's Medical Center of Dallas, why he questions the clinical value of β-d-glucan testing.
机译：侵入性真菌感染是接受免疫抑制疗法的患者（例如实体器官和造血干细胞移植（HSCT）接受者）发病率和死亡率的重要原因。与这些感染相关的许多真菌是血管侵入性的，最好通过可视化深层组织中的生物或从深层组织中培养出来进行诊断。但是，获得这种组织通常需要侵入性程序。许多HSCT接受者患有血小板减少症，由于潜在的出血并发症，这样的手术风险太大。另外，阳性血液培养物对于具有血管侵入性真菌感染的患者很少，因此这种诊断策略价值不大。这些患者人群中未经诊断的真菌感染是导致死亡的重要原因。在中性粒细胞减少或移植物抗宿主病期间，预防性使用抗真菌药（例如棘球and素）可能会预防某些真菌感染，但增加其他感染的风险。检测体液中的真菌抗原，包括隐球菌荚膜多糖，组织胞浆抗原，半乳甘露聚糖和β-d-葡聚糖，被认为在临床上至少可用于诊断性侵袭性真菌感染。 β-d-葡聚糖是一种有吸引力的抗原，因为它存在于多种真菌病原体中，包括常见的病原体念珠菌，曲霉和初生肺孢子菌。与还描述了某些血液透析滤器，β-内酰胺类抗菌剂和免疫球蛋白，这些引起人们对假阳性试验的关注。因此，必须严格监控此测试的使用。在这一点上，我们要求梅奥诊所的传染病血清学实验室主任伊丽莎·赛尔（Elitza Theel）回答她为什么认为该测试对浸润性真菌感染的诊断具有价值的原因。我们问过达拉斯儿童医学中心临床微生物学主任克里斯托弗·多恩（Christopher Doern），他为何对β-d-葡聚糖检测的临床价值提出质疑。

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