611. Utility of b-Glucan and Galactomannan Assays in the Diagnosis of Fungal Diseases in Severe Burn Patients
Session: Abstracts: Mycology
Friday, October 22, 2010

Fungal infections are associated with increased mortality in burn patients. Traditional diagnosis of fungal infections in burn patients is performed using histopathology and culture; both insensitive and result in diagnostic and treatment delays. This study evaluates the clinical use of fungal serologies in burn patients.


Consecutive patients with thermal burns admitted to the Burn ICU identified by review of laboratory records from 1/2008-4/2010 were included if they had at least one b-glucan (BG) or galactomannan (GM) assay. A positive BG is > 80 pg/mL and a positive GM index > 0.5.


In 38 patients, 152 BG results were available (median 275; 134 values (27 patients) >80).  For patients with more than 5 total BG and GM values, there were 126 (15 patients) with BG values (median 308; 114 (14 patients) > 80). There were 142 GM values (41 patients) (median 0.2; 36 values (15 patients) > 0.5). In patients with more than 5 total BG and GM, 16 patients had 112 GM (median 0.3; 24 (13 patients) >0.5). There were 17 patients with documented fungal disease within 7 days of BG and/or GM assays. Of these patients, 9 had only BG drawn within 7 days. 7 patients had positive BG; 5 with yeast (4 Candida) from BAL, tissue, or urine culture; 1 with mold (Penicillium and Trichosporon) from tissue culture; and 1 with mold (Aspergillus) and yeast (Candida) from tissue culture. 2 patients had negative BG; 1 had Fusarium from a skin culture and 1 had Candida from urine culture. 3 patients had GM drawn within 7 days of documented fungal disease; 1 positive GM result (Candida from a tracheal aspirate) and 2 negative GM (1 Candida from a BAL, 1 Candida from a catheter tip). 6 patients had fungal disease and both assays within 7 days, all had positive BG and negative GM. Of these patients, 4 had yeast (3 Candida, 1 Candida, 1 Kluyveromyces) from urine, blood, or BAL cultures. 2 patients had tissue cultures with molds (1 Bipolaris, 1 Aspergillus). 


In this small sample of burn patients, BG and GM were not reliable to exclude or diagnose an ongoing fungal disease.

Subject Category: M. Mycology including clinical and basic studies of fungal infections

Dana M. Blyth, M.D. , Internal Medicine, San Antonio Military Medical Center, San Antonio, TX
Duane R. Hospenthal, MD , Brooke Army Medical Center, Fort Sam Houston, TX
Kevin K. Chung, MD , US Army Institute of Surgical Research, Fort Sam Houston, TX, Brooke Army Medical Center, San Antonio, TX
Leopoldo C. Cancio, MD , Brooke Army Medical Center, San Antonio, TX
Booker T. King, MD , Brooke Army Medical Center, San Antonio, TX
Clinton Murray, MD, FIDSA , Brooke Army Medical Center, Fort Sam Houston, TX


D. M. Blyth, None

D. R. Hospenthal, None

K. K. Chung, None

L. C. Cancio, None

B. T. King, None

C. Murray, None

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