Combination of serum galactomannan with plasma 1, 3-β-D glucan in diagnosis of invasive fungal infections

Abstract

Objective To evaluate the combination of serum galactomannan test (GM test) with plasma 1, 3-β-D-glucan test (G test) in diagnosis of invasive fungal infections (IFI). Methods A total of 261 patients with hematologic malignancies admitted in Zhejiang Provincial Hospital of Traditional Chinese Medicine from September 2012 to November 2013 were enrolled, including 1 patient with confirmed IFI, 24 with clinically diagnosed IFI, 50 with suspended IFI and 186 patients with excluded IFI. Serum galactomannan and plasma 1, 3-β-D-glucan were detected with enzyme-linked immunosorbent assay (ELISA) and dynamic turbidimetric assay, respectively. Changes on aspergillus galactomannan antigen and 1, 3-β-D glucan concentrations before and after treatment were observed. And chi-square test was used to compare sensitivities, specificities, negative predictive values and positive predictive values of GM test and G test and the combination of GM and G tests in diagnosing IFI. Results Within 261 patients, 57 were positive in GM test, and 73 were positive in G test. The sensitivity, specificity, negative predictive value and positive predictive value of GM test were 92.0%, 97.3%, 82.1% and 98.9%; Those of G test were 96.0%, 89.8%, 55.8% and 99.4%; And those of GM combined with G test were 92.0%, 97.8%, 85.2% and 99.4%. Compared with G test, the specificity and positive predictive value were higher when GM combined with G test (χ2=10.399 and 6.393, P<0.05). In those who responded to voriconazole treatment, serum GM test and plasma M test showed a decreased value after the treatment. Conclusions GM and G tests are of value in diagnosis of IFI, and the combination of GM and G tests can improve the diagnostic specificity. Dynamic change of GM and G test values can reflect the therapeutic response. Key words: Fungi; Beta-glucans; Galactomannan; Infections; Diagnosis