نوع مقاله : مقاله پژوهشی

نویسندگان

1 کارشناسی ارشد، بخش بیوشیمی، دانشگاه آزاد اسلامی واحد شیراز، شیراز، ایران

2 استادیار، مولکولار پاتولوژی و سیتوژنتیک، بخش پاتولوژی، دانشکده پزشکی، دانشگاه علوم پزشکی شیراز، شیراز، ایران

3 استادیار، بخش هماتولوژی و انکولوژی، بخش داخلی، دانشکده پزشکی، دانشگاه علوم پزشکی شیراز، شیراز، ایران

4 کارشناسی ارشد، درمانگاه شهید مطهری، بخش پاتولوژی، دانشگاه علوم پزشکی شیراز، شیراز، ایران

10.30476/smsj.2022.91720.1280

چکیده

مقدمه: بیماری های قارچی مهاجم با افزایش مرگ و میر بیماران دارای بدخیمی های خون  در ارتباط می باشد.از این رو تشخیص و درمان به موقع  بیماری های قارچی در این بیماران ضروری  بوده و میتواند مرگ و میر آنها را کاهش دهد.با توجه به تهاجمی و زمان بر بودن روش های تشخیص قطعی تشخیص عفونتهای قارچی، روشهای سریع تر و غیر تهاجمی مانند روشهای سرولوژیک تشخیصی میتوانند به عنوان روش های کمکی در ارزیابی عفونت های فرصت طلب در بیماران دارای نقص سیستم ایمنی استفاده شوند. این روش های تشخیصی جدید،تشخیص زود هنگام و به دنبال ان امکان درمان به موقع را فراهم می کند.
روش‌ها: برای انجام این مطالعه، نمونه خون 68 بیمار مبتلا به بدخیمی های خونی مشکوک به عفونت های قارچی، جهت انجام تست تشخیصی آنتی ژن بتا دی گلوکان به روش الیزا مورد بررسی قرار گرفت و ارتباط مثبت شدن تست با نوع بدخیمی و همچنین علامتهای بالینی و پاراکلینیکی بررسی گردید.
یافته‌ها: در بین بیماران 43 نفر مرد و 25 نفر زن بودند و تست مثبت در 79% موارد مشاهده گردید.
نتیجه گیری: هرچند نتایج این مطالعه حاکی از عدم  ارتباط نوع بدخیمی، علائم بالینی و یافته های پاراکلینیکی با مثبت شدن تست بتا دی گلوکان بود. با در نظر گرفتن احتمال بالای موارد مثبت کاذب به علت احتمال عفونتهای باکتریال همزمان و مصرف آنتی بیوتیکها در بیماران دارای ضعف سیستم ایمنی، نتایج این مطالعه نشان داد که ارزیابی بتا دی گلوکان تست مناسبی برای تشخیص زود هنگام بیماری های قارچی مهاجم در بیماران دارای سرطان خون نمی باشد. 

کلیدواژه‌ها

عنوان مقاله [English]

Efficacy of Beta D- Glucan Serologic Test in Invasive Fungal Infections Early Detection in Patients with Hematologic Malignancies in Southern Iran

نویسندگان [English]

  • Elahe Zahedi 1
  • Amir Reza Dehghanian 2
  • Alireza Rezvani 3
  • Aboozar Barzegar 4

1 M.Sc., Department of Biochemistry, Shiraz Branch, Islamic Azad University, Shiraz, Iran

2 Assistant Professor, Molecular pathology and cytogenetics division, Department of Pathology, Shiraz University of Medical Sciences, Shiraz, Iran

3 Assistant Professor, Department of Hematology and Medical Oncology, Shiraz University of Medical Sciences, Shiraz, Iran

4 M.Sc., Motahari Polyclinic, Department of Pathology, Shiraz University of Medical Sciences, Shiraz, Iran

چکیده [English]

Introduction: Fungal infections are a major concern in immunocompromised patients, such as patients with hematologic malignancies and bone marrow transplants. Opportunistic infections such as invasive fungal infections can lead to poor outcomes and a high probability of death in such patients. Gold standard methods of fungi detection are intrusive and time-consuming. Therefore, they may not be the method of choice to detect such infections rapidly; however, they are always mandatory. Next to gold-standard methods, serologic methods are rapid and non-invasive methods that have been approved for use as an adjunct to classic methods for quicker detection of fungal infections.
Methods: In this study, 68 patients diagnosed with hematologic malignancies and suspicious of fungal infection were enrolled to detect fungi with serologic testing of Beta D-Glucan using ELISA. The authors evaluated the association of malignancy type, clinical signs, and patients’ para-clinical data with positive Beta D-Glucan tests.
Results: Out of 43 men and 25 women participating in this study, 79% had positive test results.
Conclusion: There was no significant association between malignancy type, clinical signs, patients’ para-clinical data, and their positive serology tests. Considering the probable false-positive results due to infection and the use of certain antibiotics in such immunocompromised patients, the authors concluded that the Beta D-Glucan ELISA test might not be a sensitive diagnosis means to diagnose fungal infections in patients with hematologic malignancies.

کلیدواژه‌ها [English]

  • Hematologic Neoplasms
  • Invasive Fungal Infections
  • Beta-D-Glucan
  1. Odabasi Z, Mattiuzzi G, Estey E, Kantarjian H, Saeki F, Ridge RJ, et al. β-D-glucan as a diagnostic adjunct for invasive fungal infections: validation, cutoff development, and performance in patients with acute myelogenous leukemia and myelodysplastic syndrome. Clinical Infectious Diseases. 2004;39(2):199-205.
  2. Pickering JW, Sant HW, Bowles CA, Roberts WL, Woods GL. Evaluation of a (1→ 3)-β-D-glucan assay for diagnosis of invasive fungal infections. Journal of clinical microbiology. 2005;43(12):5957-62.
  3. Pagano L, Caira M, Candoni A, Offidani M, Fianchi L, Martino B, et al. The epidemiology of fungal infections in patients with hematologic malignancies: the SEIFEM-2004 study. Haematologica. 2006;91(8):1068-75.
  4. Marr KA, Carter RA, Crippa F, Wald A, Corey L. Epidemiology and outcome of mould infections in hematopoietic stem cell transplant recipients. Clinical Infectious Diseases. 2002;34(7):909-17.
  5. Pfaller MA, Pappas PG, Wingard JR. Invasive fungal pathogens: current epidemiological trends. Clinical Infectious Diseases. 2006;43(Supplement_1):S3-S14.
  6. Morrell M, Fraser VJ, Kollef MH. Delaying the empiric treatment of Candida bloodstream infection until positive blood culture results are obtained: a potential risk factor for hospital mortality. Antimicrobial agents and chemotherapy. 2005;49(9):3640-5.
  7. Heussel CP, Kauczor H-U, Heussel GE, Fischer B, Begrich M, Mildenberger P, et al. Pneumonia in febrile neutropenic patients and in bone marrow and blood stem-cell transplant recipients: use of high-resolution computed tomography. Journal of Clinical Oncology. 1999;17(3):796-.
  8. De Pauw B, Walsh TJ, Donnelly JP, Stevens DA, Edwards JE, Calandra T, et al. Revised definitions of invasive fungal disease from the European organization for research and treatment of cancer/invasive fungal infections cooperative group and the national institute of allergy and infectious diseases mycoses study group (EORTC/MSG) consensus group. Clinical infectious diseases. 2008;46(12):1813-21.
  9. Wirk B, Wingard JR. Current approaches in antifungal prophylaxis in high risk hematologic malignancy and hematopoietic stem cell transplant patients. Mycopathologia. 2009;168(6):299-311.
  10. Ellepola AN, Morrison CJ. Laboratory diagnosis of invasive candidiasis. Journal of microbiology. 2005;43(spc1):65-84.
  11. Reimer LG, Wilson ML, Weinstein MP. Update on detection of bacteremia and fungemia. Clinical microbiology reviews. 1997;10(3):444-65.
  12. Preuner S, Lion T. Towards molecular diagnostics of invasive fungal infections. Expert review of molecular diagnostics. 2009;9(5):397-401.
  13. Tzianabos AO. Polysaccharide immunomodulators as therapeutic agents: structural aspects and biologic function. Clinical microbiology reviews. 2000;13(4):523-33.
  14. Koo S, Bryar JM, Page JH, Baden LR, Marty FM. Diagnostic performance of the (1→ 3)-β-d-glucan assay for invasive fungal disease. Clinical infectious diseases. 2009;49(11):1650-9.
  15. Cuenca-Estrella M, Bassetti M, Lass-Flörl C, Ráčil Z, Richardson M, Rogers TR. Detection and investigation of invasive mould disease. Journal of antimicrobial chemotherapy. 2011;66(suppl_1):i15-i24.
  16. Chen SC, Kontoyiannis DP. New molecular and surrogate biomarker-based tests in the diagnosis of bacterial and fungal infection in febrile neutropenic patients. Current opinion in infectious diseases. 2010;23(6):567-77.
  17. He S, Hang J-P, Zhang L, Wang F, Zhang D-C, Gong F-H. A systematic review and meta-analysis of diagnostic accuracy of serum 1, 3-β-D-glucan for invasive fungal infection: focus on cutoff levels. Journal of Microbiology, Immunology and Infection. 2015;48(4):351-61.
  18. Senn L, Robinson JO, Schmidt S, Knaup M, Asahi N, Satomura S, et al. 1, 3-β-D-glucan antigenemia for early diagnosis of invasive fungal infections in neutropenic patients with acute leukemia. Clinical Infectious Diseases. 2008;46(6):878-85.
  19. Pazos C, Pontón J, Palacio AD. 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. Journal of clinical microbiology. 2005;43(1):299-305.
  20. Marty FM, Lowry CM, Lempitski SJ, Kubiak DW, Finkelman MA, Baden LR. Reactivity of (1→ 3)-β-D-glucan assay with commonly used intravenous antimicrobials. Antimicrobial agents and chemotherapy. 2006;50(10):3450-3.
  21. Metan G, Ağkuş C, Buldu H, Koc A. The interaction between piperacillin/tazobactam and assays for Aspergillus galactomannan and 1, 3-beta-D-glucan in patients without risk factors for invasive fungal infections. Infection. 2010;38(3):217-21.
  22. Ito S, Ashizawa M, Sasaki R, Ikeda T, Toda Y, Mashima K, et al. False-positive elevation of 1, 3-beta-D-glucan caused by continuous administration of penicillin G. Journal of Infection and Chemotherapy. 2018;24(10):812-4.
  23. Albert O, Toubas D, Strady C, Cousson
     J, Delmas C, Vernet V, et al. Reactivity of (1→ 3)-β-d-glucan assay in bacterial bloodstream infections. European journal of clinical microbiology & infectious diseases. 2011;30(11):1453-60.
  24. Racil Z, Kocmanova I, Lengerova M, Weinbergerova B, Buresova L, Toskova M, et al. Difficulties in using 1, 3-β-D-glucan as the screening test for the early diagnosis of invasive fungal infections in patients with haematological malignancies–high frequency of false-positive results and their analysis. Journal of medical microbiology. 2010;59(9):1016-22.
  25. Pazos C, Moragues M-D, Quindós G, Pontón J, del Palacio A. Diagnostic potential of (1, 3)-b-D-glucan and anti-Candida albicans germ tube antibodies for the diagnosis and therapeutic monitoring of invasive candidiasis in neutropenic adult patients. Rev Iberoam Micol. 2006;23:209-15.
  26. White PL, Price JS, Posso RB, Barnes RA. An evaluation of the performance of the Dynamiker® Fungus (1-3)-β-D-Glucan Assay to assist in the diagnosis of invasive aspergillosis, invasive candidiasis and Pneumocystis pneumonia. Medical mycology. 2017;55(8):843-50.