侵袭性深部真菌病的实验室诊断ppt医学课件.ppt

侵袭性深部真菌病的实验室诊断侵袭性真菌病的致病菌高危人群+高危因素=IFDIFD的高危人群和高危因素尸体解剖中侵袭性真菌感染的发生率54.84%侵袭性真菌病的流行病学特点
危险因素不断增多，发生率逐年增高趋势，确切资料有待收集整理
白念珠菌仍然是最常见临床分离致病菌
非白念珠菌增加（带来的问题）
曲霉已成为重要的致死真菌真菌感染的实验诊断方法及问题真菌抗原、细胞壁成分检测新生隐球菌乳胶凝集试验血清GM作为诊断的早期标志物在BAL中检测GM作为早期诊断标志关于GM试验与G试验Prospectiveutilityof(1-3)-B-D-Glucan(BG),galactomannan(GM)andanti-Candida
albicansgermtubeantibodies(CAGT)forthediagnosisofinvasivefungaldisease(IFD)inhaemato-oncologyadultpatients
A.Alhambra1,M.S.Cuétara2,J.M.Moreno1,A.DelPalcioPerez-Medel1,I.Moragues3,J.
Pontón3,A.DelPalacio1
1HospitalUniversitarioDocedeOctubre,MADRID,Spain2HospitalUniversitarioSevero
Ochoa,LEGANES,Spain3UniversidaddelPaisVasco,BILBAO,SpainInvasiveCandidiasis
SSPPPVNPV
CAGT(%)57934496
BG(%)77863997
InvasiveAspergillosis
SSPPPVNPV
GM(%)92947398
BG(%)57844291CONCLUSIONS
TheincidenceofIFDcorrelateddirectlyandsignificantly(x2p=0.0005)withriskstratificationgroup:highestproportioninthehigh-riskgroup.
Sinceallthebiomarkershaveinherentlimitations,abetterdiagnosisyieldisachievedcombiningthebiomarkers.
AllthreebiomarkerssharehighnegativepredictivevalueandcanexcludereasonablyIFDinhaematologyadultpatientstreatedwithwidespectrumantifungals.EvaluationoftwoserologictestfordiagnosisinvasiveAspergillosis

C.Castro,A.Romero,A.Aller,T.Gonzalez,
A.González,E.Martín-Mazuelos
H.U.Valme,SEVILLA,
SpainAtotalof236serafrom51patientsinriskofIAweretestedforGMusingPlateliaAspergilluskit(BioRad,France)which36sera(10patients)weretestedforBGalsousingFungitellkit(AssociatesofCapeCod.,USA).

PatientswereattendedattheUniversityHospitalofValmefromSevillefromJanuaryof2008toDecember2008.

PatientswithGMindex≥0.5intwoconsecutivesampleshavebeenmarkedasGMpositiveandsampleswithresults≥80pg/mlweremarkedasBGpositive.AllGMpositivepatientswereclassifiedaccordingtoEORTC/MSGcriteria(2008)forprobabilityofIA.GMtestBGassayConclusion

Calculatingsignificantsensitivityforbothdetectionmethodswasnotfeasibleduetoalownumberofproven/probableAI.

BGdetectionshowedpositiveresultsbeforeGMtestandpresentthegreatadvantaget