1,3-Β-D-glukan u dijagnostici invazivnih gljivnih infekcija – prva iskustva u Hrvatskoj

Scientific paper - Review paper

• Title (croatian): 1,3-Β-D-glucan in invasive fungal infection diagnostics – first Croatian experience
• Author: Sanja Pleško
• Author: Milivoj Novak
• Author: Ernest Bilić
• Author: Violeta Rezo Vranješ
• Author: Jakša Babel
• Author: Robert Baronica
• Author: Ivana Mareković
• Author's institution: University of Zagreb; School of Medicine
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences

Abstract (english)

Invasive fungal infections (IFI) are an important problem of modern medicine. The reason is growing
population of immunocompromised patients and high morbidity and mortality of these infections. Timely
diagnosed
IFI is of utmost importance because the delay of antifungal treatment has impact on treatment
outcome.
Cultivation as a conventional diagnostic method has low sensitivity, long duration and demands obtaining
invasive samples. Therefore, in the last two decades fungal biomarkers are investigated for earlier and more
sensitive diagnostics. 1,3-β-D-glucan (BDG) is a fungal biomarker in patients’ sera that enables detection of the
following fungal pathogens: Candida spp., Aspergillus spp., Acremonium, Coccidioides immitis, Fusarium spp.,
Histoplasma
capsulatum, Trichosporon spp., Sporotrix schenckii, Saccharomyces cerevisiae and Pneumocystis jirovecii.
Low level and absence of BDG in the cell wall unables the detection of Cryptococcus spp. and order Mucorales
with this test. High negative predictive value of BDG can be used when deciding to stop antifungal treatment and
be a part of strategy for antifungal stewardship in intensive care units. In hematological patients BDG can be used
as a screening method or as a part of diagnostic work-up when IFI is suspected. Reliability of test result is higher
when two or more consecutive samples are positive. Influence of antifungal prophylaxis on BDG test results is still
unclear. BDG kinetics and its relation to clinical outcome are still investigated. For pediatric population cut-off
values for interpretation are still not defined, although many studies have been published investigating this issue.
Although still not recommended by pediatric guidelines, this test can help in certain situations having in mind its
limitations. BDG as a fungal marker represents the significant progress in IFI diagnostics. With simultaneous application
of other diagnostic methods, exact interpretation and rational use, it can help earlier and more successful
diagnostics and treatment of IFI.

Abstract (croatian)

Invazivne gljivne infekcije (IGI) važan su problem suvremene medicine. Razlog tomu jesu rastući broj
imunokompromitiranih bolesnika te visoke stope morbiditeta i mortaliteta zbog ovih infekcija. Pravodobno
postavljena dijagnoza IGI-ja od presudne je važnosti jer odgađanje primjene antifungalne terapije utječe na ishod
liječenja bolesnika. Kultivacija kao konvencionalna dijagnostička metoda ima nisku osjetljivost, dugo traje i nalaže
uzimanje invazivnog uzorka. Zbog toga se posljednjih dvadesetak godina radi ranije i osjetljivije dijagnostike istražuju
i primjenjuju fungalni biomarkeri. 1,3-β-D-glukan (BDG) fungalni je biomarker odrediv u serumu bolesnika
kojim se može dokazati prisutnost ovih gljivnih patogena: Candida spp., Aspergillus spp., Acremonium, Coccidioides
immitis, Fusarium spp., Histoplasma capsulatum, Trichosporon spp., Sporothrix schenckii, Saccharomyces cerevisiae
i Pneumocystis jirovecii. Zbog niske razine odnosno nepostojanja BDG-a u staničnoj stijenci ovim se testom ne
mogu dokazati vrste roda Cryptococcus spp. i reda Mucorales. Visoka negativna prediktivna vrijednost BDG-a u
slučaju negativne vrijednosti može se iskoristiti za donošenje odluke o prekidu antifungalne terapije i biti dio
strategije upravljanja primjenom antifungalnih lijekova u jedinicama intenzivnog liječenja. Kod hematoloških
bolesnika BDG se može primjenjivati radi probira i u sklopu dijagnostičke obrade pri sumnji na IGI. Pouzdanost
testa kod pojedinog bolesnika veća je u slučaju dvaju ili više uzastopno pozitivnih rezultata. Utjecaj antifungalne
profilakse na rezultate testa BDG-a još je nejasan. Kinetiku BDG-a za sada je teško korelirati s kliničkim ishodom.
Pedijatrijskim bolesnicima još nisu definirane granične vrijednosti za interpretaciju vrijednosti BDG-a iako su o
tome objavljena brojna istraživanja. Trenutačno vrijedeće smjernice i dalje ne preporučuju primjenu ovoga fungalnog
biomarkera kao rutinskoga dijagnostičkog testa u djece, premda može poslužiti u određenim situacijama
uzimajući u obzir njegova ograničenja. BDG kao fungalni biomarker važan je napredak u dijagnostici IGI-ja te uz
istodobnu primjenu ostalih dijagnostičkih metoda, ispravnu interpretaciju i racionalnu primjenu može pomoći
ranijem i uspješnijem postavljanju dijagnoze i liječenju bolesnika s IGI-jem.

• Language: english
• Publication type: Scientific paper - Review paper
• Publication status: Published
• Peer review: Peer review
• Publication version: Published version
• Journal title: Liječnički vjesnik
• Numbering: vol. 141, no. 3-4, pp. 97-105
• p-ISSN: 0024-3477
• URN:NBN: urn:nbn:hr:105:440517
• Publication: 2019
• Document URL: http://lijecnicki-vjesnik.hlz.hr/pdf/3-4-2019/06_plesko.pdf
• Type of resource: Text
• Access conditions: Open access
• Created on: 2024-03-28 10:23:41