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SHR Neuro Cancer Cardio Lipid Metab Microb

Schroeder, I; Dichtl, K; Liebchen, U; Wagener, J; Irlbeck, M; Zoller, M; Scharf, C.
Digestive enzymes of fungal origin as a relevant cause of false positive Aspergillus antigen testing in intensive care unit patients.
Infection. 2021; 49(2): 241-248. Doi: 10.1007/s15010-020-01506-4 [OPEN ACCESS]
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Leading authors Med Uni Graz

Dichtl Karl

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Abstract:

BACKGROUND: Galactomannan antigen (GM) testing is widely used in the diagnosis of invasive aspergillosis (IA). Digestive enzymes play an important role in enzyme substitution therapy in exocrine pancreatic insufficiency. As digestive enzymes of fungal origin like Nortase contain enzymes from Aspergillus, a false-positive result of the test might be possible because of cross-reacting antigens of the cell wall of the producing fungi. We, therefore, asked whether the administration of fungal enzymes is a relevant cause of false-positive GM antigen test results. METHODS: Patients with a positive GM antigen test between January 2016 and April 2020 were included in the evaluation and divided into two groups: group 1-Nortase-therapy, group 2-no Nortase-therapy. In addition, dissolved Nortase samples were analyzed in vitro for GM and β-1,3-D-glucan. For statistical analysis, the chi-squared and Mann‒Whitney U tests were used. RESULTS: Sixty-five patients were included in this evaluation (30 patients receiving Nortase and 35 patients not receiving Nortase). The overall false positivity rate of GM testing was 43.1%. Notably, false-positive results were detected significantly more often in the Nortase group (73.3%) than in the control group (17.1%, p < 0.001). While the positive predictive value of GM testing was 0.83 in the control group, there was a dramatic decline to 0.27 in the Nortase group. In vitro analysis proved that the Nortase enzyme preparation was highly positive for the fungal antigens GM and β-1,3-D-glucan. CONCLUSIONS: Our data demonstrate that the administration of digestive enzymes of fungal origin like Nortase leads to a significantly higher rate of false-positive GM test results compared to that in patients without digestive enzyme treatment.

Find related publications in this database (using NLM MeSH Indexing)

Antigens, Fungal - administration & dosage

Aspergillosis - diagnosis

Aspergillus - administration & dosage

Humans - administration & dosage

Intensive Care Units - administration & dosage

Invasive Fungal Infections - administration & dosage

Mannans - administration & dosage

Sensitivity and Specificity - administration & dosage

Find related publications in this database (Keywords)

Invasive aspergillosis

Critical illness

Galactomannan antigen assay

False positive results

Nortase

Digestive enzymes of fungal origin

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