Advancing the field: Evidence for new management strategies in invasive fungal infections

Current Fungal Infection Reports

Volumn 7, Issue 1, 2013, Pages 51-58

  Morrissey, C Orla ^a,b  

^a Infectious Diseases Unit   (Australia)

^b MONASH UNIVERSITY   (Australia)

Author keywords

Aspergillosis; BDG; Candidiasis; Cryptococcal meningitis; Early treatment strategies; Galactomannan; Invasive fungal infections; Mannan; PCR

Indexed keywords

1,3 BETA GLUCAN SYNTHASE; ANIDULAFUNGIN;

ARTICLE; ASSAY; CANDIDA MANNAN ASSAY; CRYPTOCOCCAL ANTIGEN BASED ASSAY; DIAGNOSTIC PROCEDURE; DIAGNOSTIC VALUE; EARLY DIAGNOSIS; EARLY INTERVENTION; ENZYME IMMUNOASSAY; GALACTOMANNAN ASSAY; HUMAN; IMMUNOASSAY; MOLECULAR DIAGNOSIS; MORBIDITY; MORTALITY; POLYMERASE CHAIN REACTION; RANDOMIZED CONTROLLED TRIAL (TOPIC); SEROLOGY; SYSTEMIC MYCOSIS;

EID: 84873714320     PISSN: 19363761     EISSN: 1936377X     Source Type: Journal    
DOI: 10.1007/s12281-012-0128-4     Document Type: Article

References (69)

1. Wisplinghoff H, Bischoff T, Tallent SM, et al. Nosocomial bloodstream infections in US hospitals: analysis of 24, 179 cases from a prospective nationwide surveillance study. [published erratum appears in Clin Infect Dis 2004, 39:1093]. Clin Infect Dis. 2004;2004(39):309-17.
2. Gudlaugsson O, Gillespie S, Lee K, et al. Attributable mortality of nosocomial candidemia, revisited. Clin Infect Dis. 2003;37:1172-77.
3. Neofytos D, Horn D, Anaissie E, et al. Epidemiology and outcome of invasive fungal infections in adult hematopoietic stem cell transplant recipients: Analysis of multicenter prospective antifungal therapy (PATH) alliance registry. Clin Infect Dis. 2009;48:265-73.
4. • Lortholary O, Gangneux JP, Sitbon K, et al. Epidemiological trends in invasive aspergillosis in France: the SAIF network (2005-2007). Clin Microbiol Infect. 2011;17:1882-89. This recent national prospective surveillance study from France provides some of the most up to date data on the incidence of invasive aspergillosis (IA) and 12-week overall mortality rates. No significant change in incidence was seen over time. Patients with chronic lymphoproliferative disorders were noted to have emerged as a new group at high-risk for IA.
5. • Park BJ, Wannemuehler KA, Marston BJ, et al. Estimation of the current global burden of cryptococcal meningitis among persons living with HIV/AIDS. AIDS. 2009;23:525-30. This paper describes the burden of cryptococcosis globally and notes that the majority of cases occur in developing countries, especially Sub-Saharan Africa.
6. Tong KB, Lau CJ, Murtagh K, et al. The economic impact of aspergillosis: analysis of hospital expenditures across patient subgroups. Int J Infect Dis. 2009;13:24-36.
7. Ananda-Rajah MR, Cheng A, Morrissey CO, et al. Attributable hospital cost and antifungal treatment of invasive fungal diseases in high-risk hematology patients: an economic modelling approach. Antimicrob Agents Chemother. 2011;55:1953-60.
8. von Eiff M, Roos N, Schulten R, et al. Pulmonary aspergillosis: early diagnosis improves survival. Respiration. 1995;62:341-47.
9. Stevens DA. Diagnosis of fungal infections; current status. J Antimicrob Chemother. 2002;49 Suppl 1:11-9.
10. •• Lamoth F, Cruciani M, Mengoli C, et al. Beta-glucan antigenemia 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;54:633-43. A meta-analysis of the performance of beta-D-glucan in a specific population of patients undergoing chemotherapy for hemato-oncological malignancies showed that the use of two positive results for diagnosis had high specificity.
11. Senn L, Robinson JO, Schmidt S, et al. 1,3-beta-d-Glucan antigenemia for early diagnosis of invasive fungal infections in neutropenic patients with acute leukemia. Clin Infect Dis. 2008;46:878-85.
12. Hachem RY, Kontoyiannis DP, Chemaly RF. et al.:Utility of galactomannan enzyme immunoassay and (1,3) beta-D-glucan in diagnosis of invasive fungal infections: low sensitivity for Aspergillus fumigatus infection in hematologic malignancy patients. J Clin Microbiol. 2009;47:129-33.
13. de Pauw B, Walsh TJ, Donnelly JP, et al. Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infection Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group. Clin Infect Dis. 2008;46:1813-21.
14. • Marchetti O, Lamoth F, Mikulska M, et al. ECIL recommendations for the use of biological markers for the diagnosis of invasive fungal diseases in leukemic patients and hematopoietic SCT recipients. Bone Marrow Transplant. 2012;47:846-54. A very recent review of the available data on biomarkers for the diagnosis of invasive fungal infections.
15. •• Posteraro B, De Pascale G, Tumbarello M, et al. Early diagnosis of candidemia in intensive care unit patients with sepsis: a prospective comparison of (1 → 3)-β-D-glucan assay, Candida score and colonization index. Crit Care. 2011;15:R249. A prospective comparison of beta-D-glucan to the Candida score and the colonisation index which showed that beta-D-glucan is more sensitive and makes a diagnosis of invasive candidiasis 1-3 days prior to culture-based diagnosis.
16. Leon C, Ruiz-Santana S, Saavedra P, et al. Usefulness of the "Candida score" for discriminating between Candida colonization and invasive candidiasis in non-neutropenic critically ill patients: a prospective multicenter study. Crit Care Med. 2009;37:1624-33.
17. Pittet D, Monod M, Sute PM, et al. Candida colonization and subsequent infections in critically ill surgical patients. Ann Surg. 1994;220:751-58.
18. Theel ES, Jespersen DJ, Igbal S, et al. Detection of (1,3)-β-D: -glucan in bronchoalveolar lavage and serum samples collected from immunocompromised hosts. Mycopathologia. 2012, Sept 1. [Epub ahead of print].
19. •• Nguyen MH, Wissel MC, Shields RK, et al. Performance of Candida real-time PCR, β-D-glucan assay, and blood cultures in the diagnosis of invasive candidiasis. Clin Infect Dis. 2012;54:1240-48. A prospective comparison of Candida real-time PCR, β-D-glucan assay, and blood cultures which showed that PCR in particular improves the ability of blood cultures to diagnose invasive candidiasis, picking up cases missed by blood cultures.
20. Karageorgopoulos DE, Qu Jm, Korbila IP, et al. Accuracy of β-d-glucan for the diagnosis of Pneumocystis jirovecii pneumonia: a meta-analysis. Clin Microbiol Infect. 2011, Dec 29. [Epub ahead of print].
21. Mikulska M, Calandra T, Sanguinetti M, et al. The use of mannan antigen and anti-mannan antibodies in the diagnosis of invasive candidiasis: recommendations from the Third European Conference on Infections in Leukemia. Crit Care. 2010;14:R222.
22. • Lunel FM, Donnelly JP, van der Lee HA, et al. Performance of the new Platelia Candida Plus assays for the diagnosis of invasive Candida infections in patients undergoing myeloablative therapy. Med Mycol. 2011;49:848-55. The new Candida antigen and antibody assays were compared to the old assays using a collection of serum samples from patients with microbiologically proven invasive candidiasis and control patients. The new assays were not more sensitive but specificity was reduced as a result of detection of mannan antigen in the serum of cases of superficial candidiasis by the new antigen assay.
23. Arendrup MC, Bergmann OJ, Larsson L, et al. Detection of candidaemia in patients with and without underlying haematological disease. Clin Microbiol Infect. 2010;16:855-62.
24. Wheat LJ, Walsh TJ. Diagnosis of invasive aspergillosis by galactomannan antigenemia detection using an enzyme immunoassay. Eur J Clin Microbiol Infect Dis. 2008;27:245-51.
25. Maertens JA, Klont R, Masson C, et al. Optimization of the cut-off for the Aspergillus double-sandwich enzyme immunoassay. Clin Infect Dis. 2007;44:1329-36.
26. Pfeiffer CD, Fine JP, Safdar N. Diagnosis of invasive aspergillosis using a galactomannan assay: A meta-analysis. Clin Infect Dis. 2006;42:1417-27.
27. Maertens J, Van Eldere J, Verhaegen J, et al. Use of circulating galactomannan screening for early diagnosis of invasive aspergillosis in allogeneic stem cell transplant recipients. J Infect Dis. 2002;186:1297-306.
28. Boutboul F, Alberti C, Leblanc T, et al. Invasive Aspergillosis in allogeneic stem cell transplant recipients: Increasing antigenemia is associated with progressive disease. Clin Infect Dis. 2002;34:939-43.
29. Miceli MH, Grazziutti ML, Woods G, et al. Strong correlation between serum Aspergillus galactomannan index and outcome of aspergillosis in patients with hematological cancer: Clinical and research implications. Clin Infect Dis. 2008;46:1412-22.
30. Fortun J, Martin-Davila P, Alvarez ME, et al. False-positive results of Aspergillus galactomannan antigenemia in liver transplant recipients. Transplantation. 2009;87:256-60.
31. Husain S, Kwak EJ, Obman A, et al. Prospective assessment of Platelia Aspergillus galactomannan antigen for the diagnosis of invasive aspergillosis in lung transplant recipients. Am J Transplant. 2004;4:796-802.
32. Huang YT, Hung CC, Liao CH, et al. Detection of circulating galactomannan in serum samples for diagnosis of Penicillium marneffei infection and cryptococcosis among patients infected with human immunodeficiency virus. J Clin Microbiol. 2009;45:2858-22.
33. •• Zou M, Tang L, Zhao S, et al. Systematic review and meta-analysis of detecting galactomannan in bronchoalveolar lavage fluid for diagnosing invasive aspergillosis. PLoS One. 2012;7:e43347. This study is a meta-analysis of the performance of galactomannan (GM) enzyme-linked immunoassay for the diagnosis of invasive aspergillosis in bronchoalveolar lavage (BAL) fluid. Using a cut-off of 1.0 the GM assay had higher sensitivity in BAL as compared with serum.
34. Marr KA, Laverdiere M, Gugel A, Leisenring W. Antifungal therapy decreases sensitivity of the Aspergillus galactomannan enzyme immunoassay. Clin Infect Dis. 2005;40:1762-69.
35. Frank UK, Nishimura SL, et al. Evaluation of an enzyme immunoassay for detection of cryptococcal capsular polysaccharide antigen in serum and cerebrospinal fluid. J Clin Microbiol. 1993;31:97-101.
36. Tanner DC, Weinstein MP, et al. Comparison of commercial kits for detection of cryptococcal antigen. J Clin Microbiol. 1994;32:1680-84.
37. Feldmesser M, Harris C, et al. Serum cryptococcal antigen in patients with AIDS. Clin Infect Dis. 1996;23:827-30.
38. Saha DC, Xess I, Jain N. Evaluation of conventional & serological methods for rapid diagnosis of cryptococcosis. Ind J Med Res. 2008;127:483-88.
39. •• Lindsley MD, Mekha N, Baggett HC, et al. Evaluation of a newly developed lateral flow immunoassay for the diagnosis of Cryptococcosis. Clin Infect Dis. 2011;53:321-25. This study shows that a novel cryptococcal lateral flow assay performs as well as the traditional diagnostic assays. In addition, it is economical, rapid and easy to perform. It has potential for use as a point-of-care test in resource-limited settings.
40. Lau A, Chen S, Sleiman S, Sorrell T. Current status and future perspectives on molecular and serological methods in diagnostic mycology. Future Microbiol. 2009;4:1185-222.
41. Avni T, Leibovici L, Paul M. PCR diagnosis of invasive candidiasis: systematic review and meta-analysis. J Clin Microbiol. 2011;49:665-70.
42. Lin MT, Lu HC, Chen WL. Improving efficacy of antifungal therapy by polymerase chain reaction-based strategy among febrile patients with neutropenia and cancer. Clin Infect Dis. 2001;33:1621-27.
43. Mengoli C, Cruciani M, Barnes RA, et al. Use of PCR for diagnosis of invasive aspergillosis: systematic review and meta-analysis. Lancet Infect Dis. 2009;9:89-96.
44. Suarez F, Lortholary O, Buland S, et al. Detection of circulating Aspergillus fumigatus DNA by real-time PCR assay of large serum volumes improves early diagnosis of invasive aspergillosis in high-risk adult patients under hematologic surveillance. J Clin Microbiol. 2008;46:3772-77.
45. • White PL, Bretagne S, Klingspor L, et al. Aspergillus PCR: one step closer to standardization. J Clin Microbiol. 2010;48:1231-40. This multi-center laboratory study identifies the factors necessary to optimize and standardize Aspergillus PCR for use in clinical studies.
46. White PL, Perry MD, Loeffler J, et al. Critical stages of extracting DNA from Aspergillus fumigatus in whole-blood specimens. J Clin Microbiol. 2010;48:3753-55.
47. Cuenca-Estrella M, Meije Y, Diaz-Pedroche C, et al. Value of serial quantification of fungal DNA by a real-time PCR-based technique for early diagnosis of invasive aspergillosis in patients with febrile neutropenia. J Clin Microbiol. 2009;47:379-84.
48. Florent M, Katsahian S, Vekhoff A, et al. Prospective evaluation of a polymerase chain reaction -ELISA targeted to Aspergillus fumigatus and Aspergillus flavus for the early diagnosis of invasive aspergillosis in patients with hematological malignancies. J Infect Dis. 2006;193:741-47.
49. •• Reinwald M, Spiess B, Heinz WJ, et al. Diagnosing pulmonary aspergillosis in patients with hematological malignancies: a multicenter prospective evaluation of an Aspergillus PCR assay and a galactomannan ELISA in bronchoalveolar lavage samples. Eur J Haematol. 2012;89:120-27. This is a multicenter comparison of Aspergillus PCR and galactomannan (GM) enzyme-linked immunoassay for the diagnosis of invasive aspergillosis in bronchoalveolar lavage (BAL) fluid. The optimal cut-off for GM in BAL was determined in this study as 0.5 and positive results for both PCR and GM made a diagnosis of invasive aspergillosis high likely.
50. Kami M, Fukui T, Ogawa S, et al. Use of real-time PCR on blood samples for diagnosis of invasive aspergillosis. Clin Infect Dis. 2001;33:1504-12.
51. Lass-Flörl C, Aigner J, Gunsilius E, et al. Screening for Aspergillus spp. using polymerase chain reaction of whole blood samples from patients with haematological malignancies. Br J Haematol. 2001;113:180-84.
52. Lass-Flörl C, Speth C, Mayr A, et al. Diagnosing and monitoring of invasive aspergillosis during antifungal therapy by polymerase chain reaction: an experimelntal study in mice. Diagn Microbiol Infect Dis. 2003;47:569-72.
53. Ferns RB, Fletcher H, Bradley S, et al. The prospective evaluation of a nested polymerase chain reaction assay for the early detection of Aspergillus infection in patients with leukaemia or undergoing allograft treatment. Br J Haematol. 2002;119:720-25.
54. Buchheidt D, Hummel M, Schleiermacher D, et al. Prospective clinical evaluation of a LightCycler™ -mediated polymerase chain reaction assay, a nested -PCR assay and a galactomannan enzyme-linked immunosorbent assay for detection of invasive aspergillosis in neutropenic cancer patients and haematological stem cell transplant recipients. Br J Haematol. 2004;125:196-202.
55. Lass-Flörl C, Gunsilius E, Gastl G, et al. Diagnosing invasive aspergillosis during antifungal therapy by PCR analysis of blood samples. J Clin Microbiol. 2004;42:4154-57.
56. Halliday C, Hoile R, Sorrell T, et al. Role of prospective screening of blood for invasive aspergillosis by polymerase chain reaction in febrile neutropenic recipients of haematopoietic stem cell transplant and patients with acute leukaemia. Br J Haematol. 2006;132:478-86.
57. White PL, Perry MD, Moody A, et al. Evaluation of analytical and preliminary clinical performance of Myconostica MycAssay Aspergillus when testing serum specimens for diagnosis of invasive Aspergillosis. J Clin Microbiol. 2011;49:169-74.
58. Hanson KE, Pfeiffer CD, Lease ED, et al. β-D-glucan surveillance with preemptive anidulafungin for invasive candidiasis in intensive care unit patients: a randomized pilot study. PLoS One. 2012;7:e42282.
59. Maertens J, Theunissen K, Verhoef G, et al. Galactomannan and computed tomography-based preemptive antifungal therapy in neutropenic patients at high-risk for invasive fungal infection: A prospective feasibility study. Clin Infect Dis. 2005;41:1242-50.
60. Barnes RA, White PL, Bygrave C, et al. Clinical impact of enhanced diagnosis of invasive fungal disease in high-risk haematology and stem cell transplant patients. J Clin Pathol. 2009;62:64-9.
61. Dignan FL, Evans SO, Ethell ME, et al. An early CT-diagnosis-based treatment strategy for invasive fungal infection in allogeneic transplant recipients using caspofungin first line: an effective strategy with low mortality. Bone Marrow Transplant. 2009;44:51-6.
62. Aguilar-Guisado M, Espigado I, Cordero E, et al. Empirical antifungal therapy in selected patients with persistent febrile neutropenia. Bone Marrow Transplant. 2010;45:159-64.
63. Cordonnier C, Pautas C, Maury S, et al. Empirical versus preemptive antifungal therapy for high-risk, febrile neutropenic patients: A randomized, controlled trial. Clin Infect Dis. 2009;48:1042-51.
64. Hebart H, Klingspor L, Klingebiel T, et al. A prospective randomized controlled trial comparing PCR-based and empirical treatment with liposomal amphotericin B in patients after allo-SCT. Bone Marrow Transplant. 2009;43:553-61.
65. Tan BH, Low JG, Chlebicka NL, et al. Galactomannan-guided preemptive vs. empirical antifungals in the persistently febrile neutropenic patient: a prospective randomized study. Int J Infect Dis. 2011;15:350-56.
66. Blennow O, Remberger M, Klingspor L, et al. Randomized PCR-based therapy and risk factors for invasive fungal infection following reduced-intensity conditioning and hematopoietic SCT. Bone Marrow Transplant. 2010;45:1710-18.
67. • Meya DB, Manabe YC, et al. Cost-effectiveness of serum cryptococcal antigen screening to prevent deaths among HIV-infected persons with a CD4+ cell count < or = 100 cells/microL who start HIV therapy in resource-limited settings. Clin Infect Dis. 2010;51:448-55. This study demonstrates the effectiveness of early diagnosis and treatment of cryptococcal disease.
68. Jarvis JN, et al. Screening for cryptococcal antigenemia in patients accessing an antiretroviral treatment program in South Africa. Clin Infect Dis. 2009;48:856-62.
69. Micol R, et al. Prevalence, determinants of positivity and clinical utility of cryptococcal antigenemia in Cambodian HIV-infected patients. J Acquir Immune Defic Syndr. 2007;45:555-59.