Galactomannam: biomarker of invasive Aspergillosis

Janaina Cândido Fernandes, Milton Camplesi Junior, Fábio Silvestre Ataides

Resumo


Galactomannan (GM) is a polysaccharide cell-wall component present in fungi of the genus Aspergillus. Within the genus, the specie A. fumigatus is noteworthy, once it is the main etiological agent of the invasive aspergillosis (AI), an opportunistic fungal infection that is related with considerable morbidity and mortality, especially in neutropenic patients. The identification of GM in biological samples in the initial phases is considered useful for the diagnosis of infection. The most widely used assay for detection of antigen is elisa immunoassay, a simple, objective and specific
test. The present study aims review literature dates associated with the invasive infection caused by fungi of the genus Aspergillus, as well as the detection of GM antigen for the diagnosis of the disease and the possible interferences in the
assay. Invasive aspergillosis affects mainly lungs, but it can spread to other parts of the body, like liver, kidney and central nervous system. For diagnosis of disease, the investigation of GM using elisa immunoassay enables to detect the antigen before the clinical manifestations or other tests positive, furthering an early diagnosis. However, false positive results can be found in patients on treatment with some antibiotics or cross-reactivity with other fungi, while false negatives can occur associated with antifungal therapy or analytical problems. Therefore, although it has some limitations, the use of biomarker GM contributes largely in the diagnosis of AI in neutropenic patients, especially when combined
with other diagnostic methods, may promote a rapid and effective diagnosis, resulting in improved patient outcomes.

Galactomanana: Biomarcador de Aspergilose Invasiva

Galactomanana (GM) é um polissacarídeo presente na parede celular de fungos do gênero Aspergillus. Dentro do gênero se destaca a espécie A. fumigatus, principal agente etiológico da aspergilose invasiva (AI), infecção fúngicaoportunística que está relacionada com altas taxas de morbimortalidade, principalmente em pacientes neutropênicos. A identificação da GM em amostras biológicas nos estágios iniciais é considerada útil para o diagnóstico da infecção. O ensaio mais utilizado para detecção deste antígeno é Elisa imunoensaio, um teste simples, objetivo e específico. O presente estudo teve como objetivo levantar dados da literatura em relação à infecção invasiva causada por fungos do gênero Aspergillus, bem como a dosagem do antígeno GM para diagnóstico da doença e os possíveis interferentes no ensaio. A aspergilose invasiva atinge principalmente pulmões, podendo afetar outros orgãos, como fígado, rins e sistema nervoso central. Para diagnóstico da doença, a detecção do GM pelo Elisa imunoensaio permite identificar o antígeno antes do início das manifestações clínicas ou positividade em outros exames, favorecendo um diagnóstico precoce. Entretanto, resultados falso-positivos podem ser observados em pacientes tratados com alguns antibióticos ou reações cruzadas com outros fungos, enquanto falso-negativos podem ocorrer relacionados ao uso de terapia antifúngica ou problemas analíticos. Sendo assim, apesar de apresentar algumas limitações, o uso do biomarcador GM contribui amplamente no diagnóstico da AI em pacientes neutropênicos, especialmente quando associada a outras metodologias diagnósticas, podendo promover um diagnóstico rápido e eficaz, resultando em melhor sobrevida do paciente.

Palavras-chave


Antigen Galactomannan; Neutropenics; Aspergillus; Antígeno Galactomanana; Neutropênicos; Aspergillus.

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DOI: http://dx.doi.org/10.18224/evs.v0i0.5538

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