Antigènes fongiques en réanimation : tests disponibles et état des lieux |
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| Affiliation: | 1. Department of Internal Medical Oncology, the Affiliated Tumor Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China;2. Department of Pathology, the Affiliated Tumor Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China;3. Department of Biomedical and Pharmaceutical Sciences, College of Pharmacy, The University of Rhode Island, Pharmacy Building, 7 Greenhouse Road, Kingston, RI 02881, USA;1. Molecular and Cellular Diagnosis Processes, Centre of Biotechnology of Sfax, University of Sfax, Route Sidi Mansour, Po Box 1177, 3018 Sfax, Tunisia;2. Department of Pathology, Habib Bourguiba hospital, Sfax, Tunisia;1. Institute for Frontier Medical Sciences, Kyoto University, Kyoto 606-8507, Japan;2. Institute for Virus Research, Kyoto University, Kyoto 606-8507, Japan;1. Critical Care Department, Hospital del Mar, Barcelona, Spain;2. Critical Illness Research Group (GREPAC), Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Barcelona, Spain;3. Division of Pulmonary Diseases & Critical Care Medicine, University of Texas Health San Antonio, San Antonio, TX, USA;4. Respiratory Department, Hospital del Mar, IMIM, Barcelona, Spain;5. Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Spain;6. Section of Pulmonary & Critical Care Medicine, South Texas Veterans Health Care System, San Antonio, TX, USA;7. Department of Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain;1. Department of Transfusion Medicine, Faculty of Medicine, Siriraj Hospital, Bangkok, Thailand;2. Department of Medicine, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand;1. CHU Clermont-Ferrand, service d’hématologie clinique adulte et de thérapie cellulaire, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand cedex 01, France;2. Université d’Auvergne, EA7283, CIC501, BP 10448, 63000 Clermont-Ferrand, France;3. Hopital Saint-Louis, service d’hématologie-greffe, 75010 Paris, France;4. Centre Jean-Perrin, service de radiothérapie, Clermont-Ferrand, 63000 Clermont-Ferrand, France |
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| Abstract: | Numerous serological assays try to supply the pitfalls of microbiological diagnostic methods for fungal infections. Several antigens have been assessed: the galactomannan (GM), the mannan (Mn), the β-glucan (ßG), and the capsular antigen for the diagnosis of invasive aspergillosis, yeast infections, all the fungal infections, and the Cryptococcus neoformans infection respectively. The performance characteristics of these assays are usually satisfactory when serum samples collected in well defined clinical settings are used. In contrast, the results of prospective studies are often disappointing. This underlines the difficulty in standardizing the patient populations and the definitions of fungal infections. For the GM assay, the conclusions obtained in onco-hematology can be used for immunocompromised patients hospitalized in intensive care units. For the Mn assays, the hope relies on the simultaneous detection of both antigen and antibodies. The advantage over the microbiological screening for yeasts of different anatomical sites remains to be demonstrated. For the βG assay, its best interest seems to be its negative predictive value as bacterial and fungal infections are hardly distinguished when the test is positive. Excepted for the capsular cryptococcal antigen, a single test is usually not contributive for any of the assays, which should be implemented as a screening test for patients at risk for fungal infections. |
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