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Negative (1,3)-β-D-glucan and Elevated White Blood Cells Combined Procalcitonin Masquerading as Severe Pneumonia Eventually Diagnosed as Invasive Pulmonary Aspergillosis Proven by Bronchoalveolar Lavage Fluid Culture in a Diabetes Patient: a Case Report and Literature Review.
Ge, YL, Zhang, Q, Wang, MH, Li, LQ, Fu, AS, Liu, CH, Zhang, HF, Li, WQ, Chen, Y, Zhang, S, et al
Clinical laboratory. 2019;(8)
Abstract
BACKGROUND We report an invasive pulmonary aspergillosis (IPA) with negative (1,3)-β-D-glucan and dynamically elevated white blood cells combined with procalcitonin proven by bronchoalveolar lavage fluid (BALF) culture. METHODS Appropriate laboratory tests are carried out. Chest CTs were performed to assess the lungs. The cause of infection was determined using BALF culture. RESULTS Serum (1,3)-β-D-glucan was negative, white blood cells and procalcitonin were significantly higher than normal. The bronchoscopy revealed obvious necrotic detritus and pseudo membrane in the trachea, left and right main bronchi, and branches. BALF culture revealed the presence of Aspergillus. CONCLUSIONS Negative (1,3)-β-D-glucan is not safe to rule out invasive pulmonary aspergillosis. BALF culture is critical for IPA diagnosis.
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2.
Positive Serum Beta-D-glucan by G Test and Aspergillus Fumigatus Sputum Culture Mimic Invasive Pulmonary Aspergillosis in a Pulmonary Nocardia Patient: a Case Report and Literature Review.
Ge, YL, Zhu, XY, Hu, K, Zhang, Q, Li, WQ, Zhang, C, Shao, DF, Wang, L, Zhang, HF, Liu, CH, et al
Clinical laboratory. 2019;(6)
Abstract
BACKGROUND Invasive pulmonary aspergillosis and nocardia overlap in clinical and radiological presentations, so differentiating between nocardia and invasive pulmonary aspergillosis is confusing. Though sputum culture could distinguish between nocardia and aspergillus fumigatus, but for the ultimate diagnosis, sputum culture provided limited help. Here we report a case of a patient with positive G test and aspergillus fumigatus sputum culture mimic invasive pulmonary aspergillosis ultimately diagnosed as nocardia through bronchoalveolar lavage culture combined metagenomic next-generation sequencing (NGS). METHODS Bronchoalveolar lavage culture combined metagenomic NGS for infectious diseases were performed for diagnosis. RESULTS Bronchoalveolar lavage culture combined metagenomic next-generation sequencing showed Nocardia Gelsenkirchen. CONCLUSIONS Positive G test and sputum culture were not specific, while bronchoalveolar lavage culture and NGS gave more information for a differential diagnosis between nocardia and aspergillus fumigatus.
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3.
Nutraceutical functions of beta-glucans in human nutrition.
Ciecierska, A, Drywień, ME, Hamulka, J, Sadkowski, T
Roczniki Panstwowego Zakladu Higieny. 2019;(4):315-324
Abstract
Recent studies have shown that naturally occurring substances found in the food of the daily human diet are important for preventing chronic non-communicable diseases. One of them is beta-glucan, which is a natural polysaccharide, occurring in plant cell walls, mainly oats, barley and wheat. It is also present in baker’s yeast cells, fungal cell walls, and some microorganisms. Beta-glucan belongs to one of the dietary fiber fractions, which are attributed a number of beneficial health properties, including the prevention and treatment of certain digestive diseases and supporting the immune system. This compound has biological activity that depends on the size, molecular weight, conformation, frequency of bonds, solubility and changes in structure. Beta-glucan reduces cholesterol and glucose concentrations in the blood, which reduces the risk of cardiovascular disease and diabetes. In addition to its effects on lipid levels and glucose metabolism, beta-glucan also exhibits antioxidant properties by scavenging reactive oxygen species, thereby reducing the risk of diseases, including atherosclerosis, cardiovascular diseases, neurodegenerative diseases, diabetes, and cancer. Immunostimulatory and antitumor effects have also been reported. The immunostimulatory activity of beta-glucan occurs as a result of its attachment to specific receptors present on the immune cell surface. Beta-glucan belongs to the group of prebiotics which stimulate the growth and activity of the desired natural intestinal microbiota, while inhibiting the growth of pathogens. It plays an important role in the proper functioning of the gastrointestinal tract and preventing inflammation as well as colon cancer. Such a number of health benefits resulting from the properties of beta-glucan may play a key role in improving health and preventing chronic non-communicable diseases, such as diabetes, hypercholesterolemia, obesity, cardiovascular diseases, and cancer.
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4.
Hypocaloric, plant-based oatmeal interventions in the treatment of poorly-controlled type 2 diabetes: A review.
Storz, MA, Küster, O
Nutrition and health. 2019;(4):281-290
Abstract
BACKGROUND Lifestyle interventions, including dietary modifications, play a key role in the treatment of type 2 diabetes. By the second half of the last century, dietary oatmeal interventions had frequently been used in patients with diabetes; however, with the widespread introduction of insulin, this practice gradually fell into disuse. Within the last decades, the original oatmeal intervention, first described in 1903, has been modified towards a hypocaloric, low-fat, and plant-based intervention. AIM: The aim of this review was to investigate the current role of these adapted short-term dietary oatmeal interventions in the treatment of patients suffering from poorly-controlled type 2 diabetes. A special focus was put on opportunities for and barriers to its clinical implementation and its potential mechanisms of action. METHODS The electronic databases of PubMed and Google Scholar were searched using the keywords "oat," "oats," "oatmeal," and "diabetes." RESULTS While there are a limited number of clinical studies including hypocaloric short-term dietary oatmeal interventions, there is evidence that these interventions may lead to a significant decrease in mean blood glucose levels and a significant reduction of insulin dosage in patients suffering from poorly-controlled type 2 diabetes. CONCLUSION Modified short-term dietary oatmeal interventions are an effective and economical tool in the treatment of patients suffering from poorly-controlled type 2 diabetes.
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5.
Infectious Agents as Stimuli of Trained Innate Immunity.
Rusek, P, Wala, M, Druszczyńska, M, Fol, M
International journal of molecular sciences. 2018;(2)
Abstract
The discoveries made over the past few years have modified the current immunological paradigm. It turns out that innate immunity cells can mount some kind of immunological memory, similar to that observed in the acquired immunity and corresponding to the defense mechanisms of lower organisms, which increases their resistance to reinfection. This phenomenon is termed trained innate immunity. It is based on epigenetic changes in innate immune cells (monocytes/macrophages, NK cells) after their stimulation with various infectious or non-infectious agents. Many infectious stimuli, including bacterial or fungal cells and their components (LPS, β-glucan, chitin) as well as viruses or even parasites are considered potent inducers of innate immune memory. Epigenetic cell reprogramming occurring at the heart of the phenomenon may provide a useful basis for designing novel prophylactic and therapeutic strategies to prevent and protect against multiple diseases. In this article, we present the current state of art on trained innate immunity occurring as a result of infectious agent induction. Additionally, we discuss the mechanisms of cell reprogramming and the implications for immune response stimulation/manipulation.
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6.
Use of (1→3)-β-d-glucan for diagnosis and management of invasive mycoses in HIV-infected patients.
Farhour, Z, Mehraj, V, Chen, J, Ramendra, R, Lu, H, Routy, JP
Mycoses. 2018;(10):718-722
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Abstract
People living with HIV (PLHIV) are highly vulnerable to invasive fungal infections (IFIs) due to their immune dysfunction. Diagnosis and treatment of IFIs remain challenging due to the requirement of deep tissue sampling to visualise and culture fungi before initiating treatment. Such techniques are less practical in resource-limited settings due to their cost and requirement of relatively invasive procedures. Hence, identification of surrogate markers for the early diagnosis and therapeutic monitoring of IFIs is required. Recent studies have shown that (1→3)-β-d-glucan (BDG), a major fungal cell wall antigen, represents a promising soluble marker for the presumptive diagnosis and therapeutic monitoring of IFIs in HIV-infected patients. Herein, we review findings on the merits of BDG assays in the diagnosis of IFIs and monitoring of antifungal therapies for PLHIV. Conversely to other types of immunocompromised patients, HIV infection is associated with gut damage and subsequent bacterial and fungal translocation leading to elevated BDG plasma levels.
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Biofilms and beyond: expanding echinocandin utility.
Larkin, EL, Dharmaiah, S, Ghannoum, MA
The Journal of antimicrobial chemotherapy. 2018;(suppl_1):i73-i81
Abstract
Echinocandins have been in use for over 15 years, starting with the first approval in 2001. Current trends, such as increasing resistance to fluconazole and shifts toward non-albicans spp. of Candida, suggest a growing role for echinocandins, as reflected by recent (2016) updates to guidelines that recommend echinocandins as first-line treatment for candidaemia. The efficacy, tolerability, and safety of echinocandins and their target site of action (1,3-β-d-glucan synthesis) have prompted research into potential new uses, such as for treatment of biofilm infections, MDR Candida auris and dermatophytes. Moreover, new mycobiome discoveries linking inflammatory bowel disease (IBD; for instance Crohn's disease) to fungi have led to preliminary but encouraging data regarding echinocandin therapy and treatment of IBD. In this article, we will review the available evidence and potential utility of echinocandins and 1,3-β-d-glucan synthesis inhibition in these areas of emerging interest.
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Successful treatment of Aspergillus ventriculitis through voriconazole adaptive pharmacotherapy, immunomodulation, and therapeutic monitoring of cerebrospinal fluid (1→3)-β-D-glucan.
Chen, TK, Groncy, PK, Javahery, R, Chai, RY, Nagpala, P, Finkelman, M, Petraitiene, R, Walsh, TJ
Medical mycology. 2017;(1):109-117
Abstract
Aspergillus ventriculitis is an uncommon but often fatal form of invasive aspergillosis of the central nervous system (CNS). As little is known about the diagnosis, treatment, and outcome of this potentially lethal infection, we report the strategies used to successfully treat Aspergillus ventriculitis complicating a pineal and pituitary germinoma with emphasis on the critical role of adaptive pharmacotherapy of voriconazole and serial monitoring of (1→3)-β-D-glucan in cerebrospinal fluid. We describe several rationally based therapeutic modalities, including adaptive pharmacotherapy, combination therapy, sargramostim-based immunomodulation, and biomarker-based therapeutic monitoring of the CNS compartment. Through these strategies, our patient remains in remission from both his germinoma and Aspergillus ventriculitis making him one of the few survivors of Aspergillus ventriculitis.
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Respiratory Tract Infections and the Role of Biologically Active Polysaccharides in Their Management and Prevention.
Jesenak, M, Urbancikova, I, Banovcin, P
Nutrients. 2017;(7)
Abstract
Respiratory tract infections (RTIs) are the most common form of infections in every age category. Recurrent respiratory tract infections (RRTIs), a specific form of RTIs, represent a typical and common problem associated with early childhood, causing high indirect and direct costs on the healthcare system. They are usually the consequence of immature immunity in children and high exposure to various respiratory pathogens. Their rational management should aim at excluding other severe chronic diseases associated with increased morbidity (e.g., primary immunodeficiency syndromes, cystic fibrosis, and ciliary dyskinesia) and at supporting maturity of the mucosal immune system. However, RRTIs can also be observed in adults (e.g., during exhausting and stressful periods, chronic inflammatory diseases, secondary immunodeficiencies, or in elite athletes) and require greater attention. Biologically active polysaccharides (e.g., β-glucans) are one of the most studied natural immunomodulators with a pluripotent mode of action and biological activity. According to many studies, they possess immunomodulatory, anti-inflammatory, and anti-infectious activities and therefore could be suggested as an effective part of treating and preventing RTIs. Based on published studies, the application of β-glucans was proven as a possible therapeutic and preventive approach in managing and preventing recurrent respiratory tract infections in children (especially β-glucans from Pleurotus ostreatus), adults (mostly the studies with yeast-derived β-glucans), and in elite athletes (studies with β-glucans from Pleurotus ostreatus or yeast).
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Current perspectives on the families of glycoside hydrolases of Mycobacterium tuberculosis: their importance and prospects for assigning function to unknowns.
van Wyk, N, Drancourt, M, Henrissat, B, Kremer, L
Glycobiology. 2017;(2):112-122
Abstract
Glycoside hydrolases (GHs) are enzymes that catalyze the hydrolysis of glycosidic bonds in glycoconjugates, oligo- and polysaccharides. A classification of these enzymes based on conserved sequence and structure motifs supported by the Carbohydrate Active Enzyme (CAZy) database has proven useful in the systematic groupings of similar enzymes into families. The human pathogen Mycobacterium tuberculosis employs 30 GHs to perform a variety of different functions, which can be divided into four broad categories: α-glucan metabolism, peptidoglycan remodeling, β-glycan hydrolysis and α-demannosylation. The review presented here shows how the GHs that have been characterized play a role in each category. Expanding the genomic analysis of GH presence to other Mycobacterium species has highlighted the importance of certain families-most notably GH13 and GH23-in the general genomic make-up of mycobacteria. Since many GHs are still uncharacterized and considered as "conserved hypothetical" proteins, the grouping of them into respective families provides a strong prediction on their putative biological functions.