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
Background:

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.

Methods:

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.

Results:  

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). 

Conclusion:

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

Speakers:
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

Disclosures:

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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