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Jurnal Ferry
Jurnal Ferry
Jurnal Ferry
JOURNAL READING
Ferry
DEPARTMENT OF PEDIATRICS
Faculty of Medicine – Universitas Padjadjaran
Dr. Hasan Sadikin General Hospital – Bandung
2018
ABSTRACT
(13)-β-D-Glucan (BDG) in Cerebrospinal Fluid as a Biomarker for
Candida and Aspergillus Infections of the Central Nervous System
in Pediatric Patients
Objective: Fungal infections of the central nervous system (FICNS) are important causes of
morbidity and mortality among immunocompromised pediatric patients. Standard diagnostic
modalities lack the sensitivity for detecting and therapeutically monitoring these life-threatening
diseases. Current molecular methods remain investigational. (13)-β-D-glucan (BDG) is a cell wall
component found in several fungal pathogens, including Candida and Aspergillus spp. Detecting
BDG in cerebrospinal fluid (CSF) may be an important approach for detecting and therapeutically
monitoring FICNS. To date, there has been no study that has investigated the effectiveness of CSF
BDG as a diagnostic and therapeutic marker of FICNS in children.
Method: Serial BDG levels were measured in serum and CSF samples obtained from pediatric
patients (aged 0–18 years) with a diagnosis of probable or proven Candida or Aspergillus CNS
infection.
Results: Nine cases of FICNS were identified in patients aged 1 month to 18 years. Two patients
were infected with an Aspergillus species, and 7 patients were infected with a Candida species. All
the patients at baseline had detectable BDG in their CSF. Among 7 patients who completed
therapy for an FICNS, all elevated CSF BDG levels decreased to <31 pg/mL. At the time of this
writing, 1 patient was still receiving therapy and continued to have elevated BDG levels. One
patient died from overwhelming disseminated candidiasis. The lengths of therapy for these 9
children ranged from 2 weeks to 28 months.
Conclusions: The BDG assay is useful in diagnosing and therapeutically monitoring Candida and
Aspergillus CNS infections in pediatric patients.
PENDAHULUAN
Infeksi jamur pada sistem saraf pusat / Fungal infections of central nervous system (FICNS):
- Hematogenous Candida meningoencephalitis (HCME) dan
- Aspergillosis of the central nervous system (ACNS)
√ sulit didiagnosis
√ penyebab morbiditas dan mortlitas pada pasien anak dengan
imunocompromised
PENDAHULUAN
- Polimer karbohidrat (13)-β-D-glucan (BDG) komponen dari dinding sel pada jamur
patogen: Candida dan Aspergillus spp
telah secara luas digunakan untuk mendiagnosis candidemia dan
aspergillosis paru invasif.
- Belum ada penelitian tentang efektivitas BDG sebagai biomarker diagnostik
dan terapeutik FICNSpada anak
Kultur konvensional untuk mengetes cairan serebrospinal (CSF) kurang sensitif dalam
mendiagnosis dan memonitor terapi .
BDG pada cairan sebrospinal (CSF) dapat menjadi pendekatan baru untuk mendeteksi dan
memonitor pengobatan FICNS
KERANGKA PEMIKIRAN
• FICNS proven: hasil kultur CSS atau jaringan SSP (+) fungi patogenik
• FICNS probable: kultur positif fungi patogenik dari lokasi steril + temuan
klinis/radiologis bukti infeksi SSP + kadar BDG ~31 pg/mL
PROSEDUR PENELITIAN
Ulasan rekam
Identifikasi subjek PENGUMPULAN
medis elektronik:
penelitian DATA
REDCap
• Karakteristik demografis
• Penyakit dasar
• Manifestasi klinis
Pemeriksaan serial BDG • Pemeriksaan diagnostik (kultur darah, urine, jaringan, CSS)
pada serum dan CSS • Lokasi pengambilan CSS
secara simultan • Hasil radiologis
• Terapi antibiotik
• Perjalanan penyakit
• Luaran penyakit
Berdasarkan validasi ulang, nilai normal BDG pada serum dan CSS didapatkan <31 pg/mL
HASIL PENELITIAN
KARAKTERISTIK SUBJEK
Litvintseva dkk: kadar BDG pada CSS bermanfaat dalam diagnosis dan
pengawasan terapi penderita infeksi SSP dengan etiologi Exserohilum
rostratum
Pemberian antifungal
Pencegahan paapran
secara akurat dalam
obat berlebihan
mengatasi FICNS
Penelitian pada model hewan: pada kadar BDG CSS <31 pg/mL,
hasil kultur jaringan serebral dan serebellar didapatkan negatif
Kelebihan
Keterbatasan
Pemeriksaan kadar
(13)-β-D-Glucan Dibutuhkan uji
Kadar (13)-β-D-Glucan sangat bermanfaat pada diagnostik untuk
bermanfaat dalam pasien suspek FICNS mengetahui nilai
mendiagnosis dan seperti kandidiuria pada ambang, sensitivita,
pengawasan terapi anak bayi prematur, spesifisitas (13)-β-D-
penderita FICNS kandidemia atau Glucan pada kasus
aspergilosis paru pada FICNS
populasi anak
TERIMA KASIH