Abstract
We read with interest the study by de Boer and colleagues in this Journal who examined the diagnostic potential of β-d-Glucan. 1 de Boer M.G. Gelinck L.B. van Zelst B.D. van de Sande W.W. Willems L.N. van Dissel J.T. et al. Beta-D-glucan and S-adenosylmethionine serum levels for the diagnosis of Pneumocystis pneumonia in HIV-negative patients: a prospective study. J Infect. 2011 Jan; 62: 93-100 Abstract Full Text Full Text PDF PubMed Scopus (55) Google Scholar 1,3-β-d-glucan (BG) is a component of fungal cell wall and is widely used as a marker to diagnose invasive fungal infections in immunocompromised patients. 2 Ostrosky-Zeichner L. Alexander B.D. Kett D.H. Vazquez J. Pappas P.G. Saeki F. et al. Multicenter clinical evaluation of the (1-->3) beta-D-glucan assay as an aid to diagnosis of fungal infections in humans. Clin Infect Dis. 2005 Sep 1; 41: 654-659 Crossref PubMed Scopus (561) Google Scholar Although the specificity of this marker is substantially high as demonstrated by the newest meta-analysis that included six cohort studies of patients with hematologic malignancies, 3 Lamoth F. Cruciani M. Mengoli C. Castagnola E. Lortholary O. Richardson M. et al. Beta-Glucan antigenemia assay for the diagnosis of invasive fungal infections in patients with hematological malignancies: a systematic review and meta-analysis of cohort studies from the Third European Conference on Infections in Leukemia (ECIL-3). Clin Infect Dis. 2012 Mar 1; 54: 633-643 Crossref PubMed Scopus (213) Google Scholar it is widely recognized that the specificity of BG can be decreased by several clinical factors such as hemodialysis using cellulose membranes and glucan-containing agents. 4 Marty F.M. Koo S. Role of (1-->3)-beta-D-glucan in the diagnosis of invasive aspergillosis. Med Mycol. 2009; 47: S233-S240 Crossref PubMed Scopus (104) Google Scholar Additionally, a previous study revealed that Pseudomonas aeruginosa (P. aeruginosa) bacteremia can be a cause of false-positive results in one of the BG assay methods, Fungitell (Associates of Cape Cod). 5 Mennink-Kersten M.A. Ruegebrink D. Verweij P.E. Pseudomonas aeruginosa as a cause of 1,3-beta-D-glucan assay reactivity. Clin Infect Dis. 2008 Jun 15; 46: 1930-1931 Crossref PubMed Scopus (93) Google Scholar Given the awfully high mortality rate of patients with P. aeruginosa bacteremia (30.6%), especially in neutropenic states and in insensitive antimicrobial use, 6 Osmon S. Ward S. Fraser V.J. Kollef M.H. Hospital mortality for patients with bacteremia due to Staphylococcus aureus or Pseudomonas aeruginosa. Chest. 2004 Feb; 125: 607-616 Crossref PubMed Scopus (129) Google Scholar earlier identification of specific pathogen followed by appropriate treatment is a challenging matter in immunocompromised patients. Because the levels of BG are measured in several methods, our study firstly aimed to analyze whether this unanticipated reaction of BG assay with P. aeruginosa bacteremia is seen in other widely-used BG assay. Subsequently, we sought the difference of clinical signs between fungal infections and P. aeruginosa bacteremia at the time of BG elevation.
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