Basic Verification of β-D Glucan in Leukocyte-Rich Plasma for the Diagnosis of Deep Mycosis

Shimoyama Ken; Kan Shigenori; Takahashi Gaku; Morino Gota; Yamada Yasuhiko; Inoue Yoshihiro; Inada Katsuya; Endo Shigeatsu

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자료유형: 학술저널

저자정보: Shimoyama Ken (Department of Critical Care Medicine School of Medicine Iwate Medical University Iwate Prefecture J) Kan Shigenori (Department of Critical Care Medicine School of Medicine Iwate Medical University Iwate Prefecture J) Takahashi Gaku (Department of Critical Care Medicine School of Medicine Iwate Medical University Iwate Prefecture J) Morino Gota (Department of Critical Care Medicine School of Medicine Iwate Medical University Iwate Prefecture J) Yamada Yasuhiko (Department of Critical Care Medicine School of Medicine Iwate Medical University Iwate Prefecture J) Inoue Yoshihiro (Department of Critical Care Medicine School of Medicine Iwate Medical University Iwate Prefecture J) Inada Katsuya (Department of Critical Care Medicine School of Medicine Iwate Medical University Iwate Prefecture J) Endo Shigeatsu (Department of Critical Care Medicine School of Medicine Iwate Medical University Iwate Prefecture J)

저널정보: 대한감염학회 Infection and Chemotherapy Infection and Chemotherapy 제53권 제1호

발행연도: 2021.1

수록면: 75 - 83 (9page)

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Background Currently, supplementary serological testing for β-D glucan (BDG) is often selected to diagnose deep mycosis in care covered by the health insurance in Japan. The Wako method used by our center has low sensitivity, and different studies have used different cut-off values due to factors that cause false positives and false negatives. One possible cause of false negatives is the use of platelet-rich plasma (PRP) as the sample material. Because phagocytic white blood cells (WBC) are precipitated by centrifugation and only plasma is measured, it seems unlikely that the actual amount of BDG is being measured when using PRP. Further, a frequent cause of false positives is contamination from blood products and gauze containing BDG. To resolve these issues, the blood cell separator, hydroxyethyl starch, is used to precipitate only the red blood cells to obtain leukocyte-rich plasma (LRP). We hypothesized that it might be possible to improve the diagnostic rate of deep mycosis by measuring the BDG content of plasma containing WBC and fungal components and by comparing the BDG content of PRP and LRP measured simultaneously. Materials and Methods Healthy human blood, albumin-added blood, wrung-out gauze fluid-added blood, and fungal solution-added blood were prepared, and PRP and LRP were prepared using hydroxyethyl starch. The BDG content of each sample was measured using the Wako method and compared. In addition, PRP and LRP of fungal-added blood were Gram-stained and examined under a microscope, and the number of WBCs and phagocytosed fungi was counted visually and compared. Results Measuring the BDG content of LRP confirmed that there were no false positives with LRP, and in vitro experiments comparing albumin-added false-positive blood to fungal-added blood showed significant differences between PRP and LRP only in the fungal-added blood. Conclusion Calculating the BDG-ratio (LRP/PRP) by measuring both LRP and PRP may eliminate false positives and false negatives of true deep mycosis and improve the diagnostic rate.

#Leukocyte #Platelet-rich plasma #Hydroxyethyl starch #Beta-glucan

참고문헌 (12)

참고문헌 신청

Obayashi T / 1995 / Plasma (1-->3)-beta-D-glucan measurement in diagnosis of invasive deep mycosis and fungal febrile episodes / Lancet 345:17~20

Yoshida K / 2011 / Special edition ① Dealing with deep mycosis in surgical emergencies. The usefulness of serodiagnositic methods in the diagnosis of invasive candidiasis / Journal of Japan Society for Surgical Infection 8:729~735

Mycosis Forum / 2014 / Guidelines for management of deep-seated mycoses 2014 / Kyowa Kikaku Ltd :127~129

Kan S / 2013 / Evaluation of an endotoxin-specific limulus amebocyte lysate assay using leukocyte-rich plasma for the diagnosis of gramnegative bacterial infection / J Infect Chemother 19:299~304

Yoshida K / 2011 / Clinical viability of Fungitell, a new (1→3)-β-D: -glucan measurement kit, for diagnosis of invasive fungal infection, and comparison with other kits available in Japan / J Infect Chemother 17:473~477

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