June 2021
Volume 62, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2021
Prospective Evaluation of Galactomannan Enzyme Immunoassay and (1, 3) β-D-Glucan testing in the diagnosis of Fungal Endophthalmitis in Southern India
Author Affiliations & Notes
  • JAISHREE GANDHI
    Jhaveri Microbiology, LV Prasad Eye Institute, Hyderabad, Telangana, India
    Manipal Academy of Higher Education, Manipal, Karnataka, India
  • Satyashree Gagan
    Jhaveri Microbiology, LV Prasad Eye Institute, Hyderabad, Telangana, India
  • Vivek Dave
    Smt Kannuri Santhamma Centre for vitreo-retinal diseases, LV Prasad Eye Institute, Hyderabad, Telangana, India
  • mohammad Hasnat Ali
    Centre for Clinical Epidemiology and Biostatistics, LV Prasad Eye Institute, Hyderabad, Telangana, India
  • Taraprasad Das
    Smt Kannuri Santhamma Centre for vitreo-retinal diseases, LV Prasad Eye Institute, Hyderabad, Telangana, India
  • Joveeta Joseph Ruben
    Jhaveri Microbiology, LV Prasad Eye Institute, Hyderabad, Telangana, India
  • Footnotes
    Commercial Relationships   JAISHREE GANDHI, None; Satyashree Gagan, None; Vivek Dave, None; mohammad Hasnat Ali, None; Taraprasad Das, None; Joveeta Joseph Ruben, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2021, Vol.62, 1956. doi:
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      JAISHREE GANDHI, Satyashree Gagan, Vivek Dave, mohammad Hasnat Ali, Taraprasad Das, Joveeta Joseph Ruben; Prospective Evaluation of Galactomannan Enzyme Immunoassay and (1, 3) β-D-Glucan testing in the diagnosis of Fungal Endophthalmitis in Southern India. Invest. Ophthalmol. Vis. Sci. 2021;62(8):1956.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Fungal endophthalmitis is a devastating intraocular inflammatory disease that represents ~17-25% of infectious endophthalmitis in India, but microbiological investigations have often failed to detect the causative agent, resulting in a clinical dilemma. Galactomannan (GM) and 1,3 β-D-Glucan (BG), have been previously evaluated in the diagnosis of invasive fungal infections, however, its utility in intraocular infections is not known. The aim of the study was to assess the clinical utility of vitreous GM and BG levels in the diagnosis of fungal endophthalmitis.<gdiv></gdiv>

Methods : Vitreous of 31 patients diagnosed clinically as fungal endophthalmitis between October 2018 and September 2020 and 11 patients diagnosed with non-infectious retinal disorders, as controls, were included in this study. Human GM and BG levels were determined by colorimetric assay kits (MyBioSource) and the receiver operating characteristic curves (ROC) were determined.<gdiv></gdiv>

Results : Of the 42 patients included in the infectious group, 16 were culture-positive and included Aspergillus spp. (44%), Candida spp. (31%), and other fungi (4/16; 25%). While, no significant association were found between GM and BG levels and visual outcome, significantly higher levels of vitreous GM (67.51±22.08pg/ml; p=0.009) and BG (1.53±0.30pg/ml; p=0.0002) were found in the culture-positive group compared to the control group. Additionally, both GM and BG levels were significantly higher in Aspergillus spp. compared to Candida spp. (p-value <0.05). The Area under the ROC curve (AUC) value for GM was 81% with a sensitivity of 88% and a specificity of 73% for a cutoff value of 51.36pg/ml. Further, the AUC value for BG was 93% with sensitivity and specificity of 94% and 82% with the cutoff value being 1.19pg/ml. Using that criteria, diagnosis of fungal infection was achieved in 12/15 (80%) culture-negative infectious samples by GM assay and in 15/15 (100%) by 1, 3 β-D-Glucan assays.<gdiv></gdiv>

Conclusions : Our study demonstrates the clinical utility of GM and BG as useful adjunctive biomarkers for the early diagnosis of fungal infections in patients with culture-negative endophthalmitis. A combination of both BG and GM assays would be the best approach, facilitating better predictive accuracy in vitreous fluids and may have a role in monitoring response to therapy.<gdiv></gdiv>

This is a 2021 ARVO Annual Meeting abstract.

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