Częstość wykrywania rozpuszczalnych antygenów Candida sp. i Aspergillus sp. metodami serologicznymi w płynach ustrojowych pacjentów Centralnego Szpitala Klinicznego w Warszawie
[Frequency of detection of soluble antigens of Candida spp. and Aspergillus spp. using serological assays in body fluids of patients of Central Clinical Hospital in Warsaw]

Streszczenie

W przypadkach zaburzeń funkcjonowania układu immunologicznego o różnorodnym podłożu, znacząco wzrasta ryzyko zakażeń patogenami oportunistycznymi, w tym infekcji grzybiczych. Podstawową metodą wykrycia zakażenia grzybiczego jest monitorowanie serologiczne, pozwalające

na szybkie wdrożenie leczenia przeciwgrzybiczego. Celem pracy było określenie częstości wykrywania rozpuszczalnych antygenów grzybów z rodzajów Candida sp. i Aspergillus sp. przy użyciu metod immunoenzymatycznych w próbkach materiału klinicznego, pobranych od pacjentów Samodzielnego

Publicznego Centralnego Szpitala Klinicznego w Warszawie w latach 2010-2015 oraz określenie grup chorych, szczególnie narażonych na inwazyjne zakażenia grzybicze.

Abstract

Introduction: Immunodeficient patients, e.g. transplant recipients, patients treated with corticosteroids, people with AIDS and individuals undergoing prolonged antibiotic therapy are at high risk of invasive fungal infections, especially invasive aspergillosis. Basic method for detection of organ/systemic fungal infection is serological monitoring in body fluids, first of all in serum, but also in broncho-alveolar lavages (BALF). Proven invasive

fungal infection should be diagnosed by culture of the pathogen or histopathological examination of infected tissues, however the detection of soluble fungal antigens in body fluids gives enough information for diagnosis of probable fungal infections, according to European Organization for Research and Treatment of Cancer reccommendations, what allows introduction of antifungal therapy. Aim of the study was to assess the frequency of detection of circulationg soluble fungal antigens with use of immunoenzymatic techniques in patients hospitalized between 2010 and 2015 in Independent Public Central Clinical Hospital (IPCCH) in Warsaw.

Methods: In IPCCH, between 2010 and 2015, 6475 serum samples, taken from 2096 patients, was tested for Candida spp. mannan antigen, and 7745 sera from 2243 patients were tested for galactomannan antigen of Aspergillus spp, as well as 64 samples of BALF. Material was collected mainly from haematopoietic stem cell transplant recipients, hospitalized in Haematology and Oncology Clinics, during their routine post-transplant monitoring. Testing was performed with use of quantitative (Candida antigen) or semiquantitative (Aspergillus antigen) immunoenzymatic methods (BioRad-Platelia), according to respective protocols.

Results: During examined period, increase in number of examinations was observed; starting from 1311 tests performed in 2010, up to 3052 examinations in 2015. In 2015 testing for Aspergillus antigen in BALF samples was also introduced, resulting in 64 samples tested. Candida spp. antigen was detected in 171 samples (2,7% of all tested samples), and Aspergillus galactomannan was detected in 645 serum samples (8,4%) and 8 BALF samples (12,5%). Majority of examinations was performed for patients hospitalized in Haematology and Oncology Clinics (72,7%), Blood Vessel Surgery and Transplantology Clinics (3,8%), as well as in patients under care of post-transplantation (8,3%) and haematology (4,2%) out-patient clinics.

Conclusions: (i) In the 2010-2015 visible increase in number of fungal antigens examinations was observed, (ii) significant number of examinations was performed in onco-haematological patients (88,7%), what also indicates main risk group, (iii) 8,3% of fungal antigen testing was performed in solid organ transplant recipients, the second risk group for invasive fungal infection.

Key words: invasive fungal infections, mannan, galactomannan, soluble antigens, immunoenzymatic methods