Diagnosis of Fungal Infections. A Systematic Review and Meta-Analysis Supporting American Thoracic Society Practice Guideline
| العنوان: | Diagnosis of Fungal Infections. A Systematic Review and Meta-Analysis Supporting American Thoracic Society Practice Guideline |
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| المؤلفون: | Qusay Haydour, Nancy L. Wengenack, Chadi A. Hage, Eva M. Carmona, Luke M. Gabe, Scott E. Evans, Andrew H. Limper, M. Hassan Murad, Jay K. Kolls, Kenneth S. Knox, Oleg Epelbaum, Larry J. Prokop |
| المصدر: | Annals of the American Thoracic Society. 16:1179-1188 |
| بيانات النشر: | American Thoracic Society, 2019. |
| سنة النشر: | 2019 |
| مصطلحات موضوعية: | Pulmonary and Respiratory Medicine, medicine.medical_specialty, Aspergillosis, Sensitivity and Specificity, Histoplasmosis, Serology, law.invention, Mannans, Immunocompromised Host, 03 medical and health sciences, Galactomannan, chemistry.chemical_compound, 0302 clinical medicine, law, Internal medicine, medicine, Humans, 030212 general & internal medicine, medicine.diagnostic_test, business.industry, Galactose, Guideline, medicine.disease, Intensive care unit, Bronchoalveolar lavage, 030228 respiratory system, chemistry, Practice Guidelines as Topic, business, Bronchoalveolar Lavage Fluid, Biomarkers, Invasive Fungal Infections, Blastomycosis |
| الوصف: | Rationale: Prompt diagnosis of invasive fungal infections is important because of the associated morbidity and mortality; however, diagnosis is challenging because of the nonspecific symptoms and radiographic findings.Objectives: To conduct a systematic review and meta-analysis of studies that evaluated the diagnostic accuracy of serum and bronchoalveolar lavage (BAL) galactomannan (GM) and serum or BAL polymerase chain reaction (PCR) in patients with suspected invasive aspergillosis (IA), β-d-glucan in critically ill patients at risk for candidiasis or candidemia, and serology testing and antigen detection in patients with endemic mycoses (histoplasmosis, blastomycosis, and coccidioidomycosis).Methods: Studies were selected and appraised by pairs of reviewers. Bivariate random effects meta-analysis was used to generate pooled sensitivity, specificity, and diagnostic likelihood ratios.Results: Serum GM in patients with impaired immunity suspected of having IA had sensitivity of 0.71 (95% confidence interval [CI], 0.64-0.78) and specificity of 0.89 (95% CI, 0.84-0.92). A cutoff of 1 optical density index yielded optimal sensitivity and specificity. BAL GM in patients with impaired immunity suspected of having IA had sensitivity of 0.84 (95% CI, 0.73-0.91) and specificity of 0.88 (95% CI, 0.81-0.91). Serum or whole-blood PCR in immunocompromised patients with suspected IA had sensitivity of 0.81 (95% CI, 0.73-0.86) and specificity of 0.79 (95% CI, 0.68-0.86). BAL PCR in patients at high risk for IA had high sensitivity of 0.90 (95% CI, 0.77-0.96) and specificity of 0.96 (95% CI, 0.93-0.98) for diagnosing IA. β-d-glucan assay in patients in the intensive care unit at risk for invasive candidiasis or candidemia had sensitivity of 0.81 (95% CI, 0.74-0.86) and specificity of 0.60 (95% CI, 0.49-0.71). Data on diagnostic accuracy of antigen detection and serology testing for endemic mycoses were limited and heterogeneous (varied according to test, patient immunity, and suspected endemic disease).Conclusions: The diagnosis of invasive fungal infections remains a challenge. Various serum and BAL markers can aid in diagnosis. This evidence supports the development of clinical practice recommendations by the American Thoracic Society. |
| تدمد: | 2325-6621 2329-6933 |
| الوصول الحر: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::7a488cc7a322c870a2a8ae54fcdbfc6fTest https://doi.org/10.1513/annalsats.201811-766ocTest |
| رقم الانضمام: | edsair.doi.dedup.....7a488cc7a322c870a2a8ae54fcdbfc6f |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 23256621 23296933 |
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