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  Clinical characteristics and treatment outcomes of patients with candidaemia due to Candida parapsilosis sensu lato species at a medical center in Taiwan,2000-2012

  • author:yirui
  • date:2015-12-02
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                                          Clinical characteristics and treatment outcomes of patients with candidaemia

                                     due to Candida parapsilosis sensu lato species at a medical center in Taiwan, 2000-2012

 

Scientists at a medical center in Taiwan evaluated the mycology database of the National Taiwan University Hospital and patients diagnosed with candidaemia due to C. parapsilosis sensu lato species from 2000 to 2012. 

A total of 323 adult patients with candidaemia caused by C. parapsilosis sensu lato species were evaluated, including 256 (79.3%) patients with C. parapsilosis sensu stricto, 34 (10.5%) with C. orthopsilosis, and 33 (10.2%) with C. metapsilosis. There were 222 men and 101 women and the median age was 60 years (range, 18 to 103 years). Among them, 178 (55%) had an underlying diagnosis of cancer. The overall 30-day mortality rate was 25% (n= 80). Multivariate analysis revealed that shock (P< 0. 001 ), anti-fungal therapy (P= 0. 002), central catheter removal (P= 0. 02), and abdominal surgery (P= 0. 043) were independent prognostic factors of patients with candidaemia due to C. parapsilosis sensu lato species. There were no significant differences in 30-day mortality rate among patients with candidaemia caused by the three different species (P= 0. 770). All isolates of C. metapsilosis, C. orthopsilosis, and C. parapsilosis sensu stricto were susceptible to voriconazole. Wild type isolates were susceptible to itraconazole, posaconazole and amphotericin B.

Conclusions: There were no significant differences in 30-day mortality among patients with candidaemia caused by C. parapsilosis sensu stricto, C. metapsilosis or C. orthopsilosis. The currently used anti-fungal agents exhibited good in-vitro activities against C. parapsilosis sensu lato species isolates.



                                                               The significance of serum GM and BG antigens assay 

                                               for invasive fungal infections in hematological malignancies patients


Chinese Scientists have evaluated the diagnostic value of serum galactomannan antigen (GM) and (1→3)-β-D-glucan antigen (BG) assay in invasive fungal infections (IFI) in the patients with hematologic malignancies and the role in monitoring therapeutic response.

RESULTS:

Two hundred and forty serum samples were collected from 51 patients including 2 of proven IFI, 26 probable IFI, 17 possible IFI and 6 non-fungal infection. The true-positive group including the proven and probable groups, and true negative group was the non-fungal infection group. GM tests were positive in 21 of 28 cases in true positive group, and only one of 6 cases in non-fungal infection. The sensitivity, specificity, positive predictive value and negative predictive value were 75%, 83.3%, 95.5% and 41.7%, respectively. G tests were positive in all 28 cases of the true positive group, and 4 in 6 non-fungal infection cases. The sensitivity, specificity, positive predictive value and negative predictive value were 100%, 33.3%, 87.5% and 100%, respectively. G test is more sensitive than GM test (P = 0.015), but there was no significant difference in specificity of the two tests (P = 0.242). In 19 of 21 patients with GM test positive, anti-fungal treatment was effective, and GM value gradually decreased to negative, two invalid patients were persistent with GM test positive. After two weeks treatment, the average GM value was significantly lower in the effective group than in the ineffective group (P < 0.05). BG values in the responded patients showed a gradual decline similar to that of GM values, but not to negative. The changes of BG value in ineffective group varied with a trend upward. The changes in BG value had no relation with treatment effectiveness.

CONCLUSIONS:

Serum GM and BG antigens detection provides strong evidence for early diagnosis of IFI. Combination of GM and G tests can improve the diagnostic specificity and reduce the false positive GM test seems superior to G test for monitoring GM and BG values during treatment.

 

Zhonghua Xue Ye Xue Za Zhi. 2011 Jan;32(1):43-46.

 

 

 

                                                 Early diagnosis of fungal infection in immunocompromised patients: PCR test

 

Techniques for the diagnosis of invasive fungal infection, including antigen testing, nucleic acid detection and radiological imaging, have improved greatly in recent years. They have the potential to impact on patient management through replacing empirical antifungal strategies with targeted and pre-emptive therapy. 

 

Significant advances in early diagnosis, most notably through the application of non-invasive techniques including antigen testing, nucleic acid detection and radiological detection of fungal infection, have the potential to impact on empirical strategies. When incorporated into care pathways, these techniques may be used to guide pre-emptive therapy and reduce unnecessary empirical antifungal use. Benefits from this approach include not only reduced drug acquisition costs but also reduced morbidity and mortality from drug-related adverse events and decreased hospital length of stay. The ultimate goal will be a reduction in fungal-related death and improved overall survival.

 

J. Antimicrob. Chemother.(2008) 61 (suppl 1): 3-6.