The Importance of Bronchoalveolar Lavage Sample for Galactomannan, 1,3-beta-D-Glucan and PCR Tests

Opportunistic fungal infections are life threatening especially for immunosuppressed patients. Early and accurate diagnosis is very important for the prompt initiation of treatment and to reduce unnecessary use of antifungal drugs. In recent years, efforts providing more rapid and more sensitive diagnosis of invasive fungal infections have been increasing. These methods include detection of fungal antigens, specific antibodies, fungal metabolites and DNA in the clinical samples. In this case, we report a seven year-old male patient with cystic fibrosis and diffuse large B-cell lymphoma, who presented with fever, vomiting and chronic cough. Diffuse parenchymal infiltrations and alveolar opacities in the inferior lobe of right lung and focal patchy alveolar infiltrates in different segments in both lungs were seen in thora-cal CT scanning. Bronchoalveolar lavage (BAL) sample obtained by bronchoscopy was sent to the mycology laboratory and hypha elements that were compatible with Aspergillus were seen in direct examination. Aspergillus fumigatus was isolated from the culture of BAL sample. Real-time polymerase chain reaction (Rt-PCR), galactomannan (GM = 1.08 ng/ml) and 1,3-beta-D-Glucan (BG >523 pg/ml) tests in BAL sample yielded positive results, however simultaneously performed PCR, GM (0.13 ng/ml) and BG (< 7 pg/ml) tests in serum sample were found to be negative. Treatment with voriconazole was started and continued for 45 days. The patient was discharged after improvement of his general state. It was concluded that PCR, GM and BG tests performed both in sera and BAL samples might aid to the early diagnosis and treatment of patients with invasive fungal infections in immunosuppressed patients. These data should be supported with further larger scale studies

Galaktomannan, 1,3-ß-D-Glukan ve PCR Testlerinde Bronkoalveoler Lavaj Örneğinin Önemi (The Importance of Bronchoalveolar Lavage Sample for Galactomannan, 1,3-ß-D-Glucan and PCR Tests)

Fırsatçı mantar enfeksiyonları özellikle immün yetmezlikli hastalarda önemli bir tehdit olmaya devam etmektedir. Erken ve doğru tanı, antifungal tedavinin zamanında başlanması ve toksik antifungal ajanların gereksiz kullanımını azaltmak için son derece önemlidir. Son yıllarda invazif mantar enfeksiyon (IME)’larının daha hızlı ve daha duyarlı saptanabileceği antijenlerin, özgül antikorların, fungal metabolitlerin ve DNA’nın tespitine yönelik çabalar artmıştır. Bu raporda, daha önceden kistik fibrozis ve diffüz büyük B hücreli lenfoma tanısı olan, ateş, kusma ve öksürük şikayetleriyle başvuran, bronkoalveolar lavaj (BAL) sıvı kültüründen Aspergillus fumigatus’un izole edildiği, eşzamanlı olarak BAL örneğinden yapılan 1,3-ß-D-Glucan (BG), galaktomannan (GM) ve gerçek zamanlı polimeraz zincir reaksiyonu (RtPCR) testlerinin pozitif, serum örneğinden yapılan BG, GM ve RtPCR testlerinin ise negatif olduğu 7 yaşındaki erkek hasta sunulmaktadır. Hastanın toraks bilgisayarlı tomografisinde (TBT), sağ akciğer alt lobda yaygın parankimal infiltrasyon ve alveolar opasiteler, her iki akciğerde de değişik segmentlerde yamalı alveolar fokal infiltrasyonlar izlendi. Bronkoskopiyi takiben mikoloji laboratuvarına gönderilen BAL örneğinin direkt incelenmesinde Aspergillus ile uyumlu olabilecek görünümde hifler belirlendi. Kültürde de A. fumigatus üredi. BAL RtPCR, GM ve BG sonuçları pozitif (1,08 ng/ml ve >523 pg/ml) iken eşzamanlı serum RtPCR, GM ve BG sonuçları ise negatifti (0,13 ng/ml ve 523 pg/ml respectively). RtPCR, galactomannan, 1,3-ß-D-Glucan tests in sera were found to be negative (0,13 ng/ml and <7 pg/ml respectively). Treatment with voriconazole was started and continued for 45 days. The patient was discharged with instructions after improvement of his general state. In conclusion, early diagnosis and treatment of invasive fungal infections in immunsuppressive patients affects the prognose and therefore performing PCR, Galactomannan, 1,3-ß-D-Glucan tests in sera and BAL samples would be useful and must be supported with further studies

Evaluation of Candida strains isolated from clinical specimens Klinik örneklerden izole edilen Candida türlerinin deǧerlendirilmesi

Objective: Candida spp. are the most important pathogens in critically ill patients and the epidemiology is changing. While Candida albicans remains the predominant pathogen, the proportion of infection caused by other species of Candida continues to increase. In recent years, due to the increase in incidence of infections with non-albicans strains and the development of resistance to antifungals, identification of Candida strains to species level gained significant importance.The aim of this study was to identify Candida strain isolated from various clinical specimens. Method: January 2011 to June 2012, Candida strains were isolated from 3905 clinical specimen. In identification of Candida species that were isolated, germ tube test, growth in Cornmeal-Tween 80 agar and formation of clamydospore, presence of pseudohyphae, carbonhytrate fermentation and assimilation tests, and the test of nitrate were studied Results: Finally 1122 Candida strains were isolated from 3905 various clinical specimens. The distribution of clinical specimens were as fallows: 556 from bronchoalveolar lavage (49.6%), 271 from sputum (24.2%), 114 from blood (10.2%), 51 vaginal swabs (4.6%), 50 from urine (4.4%), 30 from tissue (2.6%), 22 from endotracheal tracheal aspirate (ETA) (1.9%), nine from pleural mai (0.80%), six from peritoneal fluid (0.53%), four from gastric fluid(0.35%),three from stool(0.28%),two from abscess (0.18%),three from nail (0.26%), one from cerebrospinal fluid (0.10%). From these clinical samples 848 C. albicans (75.6%), 143 C. glabrata (12.8%), 40 C. parapsilosis, (3.57%), 33 C. krusei (2.94%), 33 C. kefyr (2.94%), 19 C. tropicalis (1.7%) were isolated. Other strains were identified as C. lusitania, C. lipolytica, C. norvegensis, C. pelliculosa ve C. zeylanoides Conclusion: It was concluded that C.albicans has still been the most frequent species among Candida isolates of in our hospital; however, the incidence of non-albicans species have increased