Diagnostic Performance of Serum (1,3) β-D Glucan to Detect Fungal Infection in Acute Leukemia Patients with Chemotherapy
DOI:
https://doi.org/10.24293/ijcpml.v27i1.1598Keywords:
(1, 3) β-D-glucan, invasive fungal infection, acute leukemia, chemotherapyAbstract
Chemotherapy is a predisposing factor for infection in patients with malignancy, while culture, as the gold standard, limits the diagnosis of fungal infections. (1,3) β-D glucans, the most abundant polysaccharide component of the fungal wall, are increased in patients with Invasive Fungal Infections (IFI). This research was an analytical observational study with a cross-sectional approach involving 60 acute leukemia patients who received chemotherapy with suspicion of fungal infection at the General Hospital of Dr. Moewardi, Surakarta, from September to October 2019. Fungal blood cultures and
serum (1,3) β-D glucan levels by the enzyme-linked immunoassay method were examined. Diagnostic tests were performed to determine sensitivity, specificity, Positive Predict Value (PPV), Negative Predict Value (NPV), Positive Likehood Ratio (PLR), Negative Likehood Ratio (NLR), and the serum's accuracy value (1,3) β-D glucan levels to fungal culture. Most (88.3%) of patients were diagnosed with Acute Lymphocytic Leukemia (ALL), maintenance chemotherapy phase (51.3%), risk factors for neutropenia (50%), and intravenous (IV) line use (56.7%). Serum (1,3) β-D glucan levels in patients with positive fungal cultures (4) in blood samples had a median of 482.87 (476.13-640.56) pg/mL, while patients with negative fungal cultures (56) had a mean±SD 298,68±114,39 pg/mL. Diagnostic test with a cut-off of 471,717 pg/mL showed sensitivity of 100.0%, specificity of 96.4%, NPV of 100%, PLR of 28.00, and NLR of 0.00 with an Area Under Curve (AUC) value of 0.982 and Coefficient Interval (CI) 95% (0.950-1.014). The measurement of serum (1,3) β-D glucan at a cut-off value of 471,717 pg/mL showed good performance as a biomarker for diagnosing and screening IFIs.
Downloads
References
Bartlett AW, Cann MP, Yeoh DK, Bernard A, Ryan AL, et al. Epidemiology of invasive fungal infections in immunocompromised children; An Australian national 10-year review. Pediatric Blood & Cancer,
; 66(4): e27564.
Patricia T. Pola jamur dan resistensi antijamur pada pasien dengan penyakit keganasan di RSUD Dr.
Moewardi Surakarta periode Januari-Desember 2019. Karya stase Mikrobiologi. Program Pendidikan
Spesialis Patologi Klinik, Fakultas Kedokteran Universitas Sebelas Maret Surakarta. 2019.
Crawford J, Dale DC, Lyman GH. Chemotherapy-induced neutropenia: Risks, consequences, and new directions for its management. Cancer, 2004; 100(2): 228-237.
Latgé JP. The cell wall: A carbohydrate armor for the fungal cell. Mol Microbiol, 2007; 66(2): 279-290.
Wright WF, Overman SB, Ribes JA. (1–3) β-D-glucan assay: A review of its laboratory and clinical application. Laboratory Medicine, 2011; 42(11): 679–85.
Iossifova Y, Reponen T, Daines M, Levin L, Hershey GKK. Comparison of two analytical methods for
detecting (1,3) β-D glucan in pure fungal cultures and in-home dust sample. The Open Allergy Journal, 2018; 1: 26-34.
Anonim. Lipopolysaccharides (LPS) ELISA kit may substitute for Limulus Amebocyte Lysate (LAL) test
reagen. Cloud-clone corp; Http www-cloudclone.com/topic/201305071641290001.html. 2013. (accessed 14 October, 2019).
Pagano L, Mayor S. Invasive fungal infections in high-risk patients: Report from TIMM-8 2017. Future
Science OA, 2018; 4(6): 1-10.
Cancer Research UK. Acute lymphoblastic leukemia phase treatment, diunduh dari https://www.
c a n c e r r e s e a r c h u k . o r g / a b o u t - c a n c e r /a c u t e - l y m p h o b l a s t i c - l e u k a e m i a - a l l /treatment/phases. 2018. (accessed 14 October, 2019).
Lien MY, Chou CH, Lin CC, Bai LY, Chiu CF, et al. Epidemiology and risk factors for invasive fungal
infections during induction chemotherapy for newly diagnosed acute myeloid leukemia: A retrospective
cohort study. PLos One, 2018; 13(6): e0197851.
Brigitte L, Pascal R, Gérard C, Jean-Pierre F, Marie L. What is the relevance of obtaining multiple blood samples for culture? A comprehensive model to optimize the strategy for diagnosing bacteremia.
Clinical Infectious Diseases, 2002; 35(7): 842–850.
Azoulay E, Guigue N, Darmon M, Mokart D, Lemiale V, et al. (1, 3)-β-D-glucan assay for diagnosing invasive fungal infections in critically ill patients with hematological malignancies. Oncotarget, 2016; 7(16): 21484–21495.
Downloads
Submitted
Accepted
Published
How to Cite
Issue
Section
License
Copyright (c) 2020 INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.