Advertisement

Current status of fungal cell wall components in the immunodiagnostics of invasive fungal infections in humans: galactomannan, mannan and (1→3)-β-D-glucan antigens

  • A. Kędzierska
  • P. Kochan
  • A. Pietrzyk
  • J. Kędzierska
Review

Abstract

Early diagnosis of fungal infections and the implementation of appropriate treatment represent major issues for clinicians, nowadays. Histopathological demonstration of microorganisms in tissue specimens or growth of fungal agents in culture media is still considered the “gold standard”, but obtaining such specimens may be difficult. Several groups have investigated serological assays for cell wall elements unique to fungal organisms in serum or other body fluids to improve diagnostics in patients with haematological malignancies or undergoing haematopoietic stem-cell transplantation. In this review we have concentrated on the currently available assays allowing for detection of highly immunogenic components of fungal cell wall: galactomannan, mannan, and also (1→3)-β-D-glucan. Rapid serological tests appear to be useful for screening high-risk haematological patients, since they allow for the early diagnosis of invasive fungal infections, including infections with the most common pathogens such as Aspergillus and Candida. Based on current literature, factors increasing the probability of obtaining false-positive or false-negative results detected by each test were also analysed and tabulated.

Keywords

Aspergillosis Invasive Aspergillosis Invasive Candidiasis Invasive Pulmonary Aspergillosis Fusariosis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgements

AK would like to thank Prof. Juliusz Pryjma, M.D., Ph.D. (Department of Immunology, Faculty of Biotechnology, Jagiellonian University, and Department of Clinical Microbiology, Jagiellonian University Medical College) for careful reading of the manuscript and helpful suggestions. P.K. would like to thank Dr J.K., M.D. from London, UK for careful reading and language consultations.

References

  1. 1.
    Enoch DA, Ludlam HA, Brown NM (2006) Invasive fungal infections: a review of epidemiology and management options. J Med Microbiol 55:809–818PubMedCrossRefGoogle Scholar
  2. 2.
    Kauffman CA (2005) Fungal infections. Proc Am Thorac Soc 3:35–40CrossRefGoogle Scholar
  3. 3.
    Pagano L, Caira M, Candoni A, Offidani M, Fianchi L, Martino B, Pastore D, Picardi M, Bonini A, Chierichini A, Fanci R, Caramatti C, Invernizzi R, Mattei D, Mitra ME, Melillo L, Aversa F, Van Lint MT, Falcucci P, Valentini CG, Girmenia C, Nosari A (2006) The epidemiology of fungal infections in patients with hematologic malignancies: the SEIFEM-2004 study. Haematologica 91:1068–1075PubMedGoogle Scholar
  4. 4.
    Martino R, Subirá M (2002) Invasive fungal infection in hematology: new trends. Ann Hematol 81:233–243PubMedCrossRefGoogle Scholar
  5. 5.
    Ostrosky-Zeichner L, Pappas PG (2006) Invasive candidiasis in the intensive care unit. Crit Care Med 34:857–863PubMedCrossRefGoogle Scholar
  6. 6.
    Segal BH, Walsh TJ (2005) Current approaches to diagnosis and treatment of invasive aspergillosis. Am J Respir Crit Care Med 173:707–717PubMedCrossRefGoogle Scholar
  7. 7.
    Warnock DW (2007) Trends in the epidemiology of invasive fungal infections. Jpn J Med Mycol 48:1–12CrossRefGoogle Scholar
  8. 8.
    Baddley JW, Pappas PG, Smith AC, Moser SA (2003) Epidemiology of Aspergillus terreus at a university hospital. J Clin Mcrobiol 41:5525–5529CrossRefGoogle Scholar
  9. 9.
    Guiot HIF, Fibbe WE, van’t Wout JW (1994) Risk factors for fungal infection in patients with malignant hematologic disorders: implications for empirical therapy and prophylaxis. Clin Infect Dis 18:525–532PubMedGoogle Scholar
  10. 10.
    Reichenberger F, Habicht JM, Gratwohl A, Tamm M (2002) Diagnosis and treatment of invasive pulmonary aspergillosis in neutropenic patients. Eur Respir J 19:743–755PubMedCrossRefGoogle Scholar
  11. 11.
    Edwards JE Jr, Bodey GP, Bowden RA, Buchner T, de Pauw BE, Filler SG, Ghannoum MA, Glauser M, Herbrecht R, Kauffman CA, Kohno S, Martino P, Meunier F, Mori T, Pfaller MA, Rex JH, Rogers TR, Rubin RH, Solomkin J, Viscoli C, Walsh TJ, White M (1997) International Conference for the Development of a Consensus on the Management and Prevention of SevereCandida Infections. Clin Infect Dis 25:43–59PubMedGoogle Scholar
  12. 12.
    Martinez JP, Gil ML, Lopez-Ribot JL, Chaffin WL (1998) Serologic response to cell wall mannoproteins and proteins ofCandida albicans. Clin Microbiol Rev 11:121–141PubMedGoogle Scholar
  13. 13.
    Yera H, Sendid B, Francois N, Camus D (2001) Contribution of serological tests and blood culture to the early diagnosis of systemic candidiasis. Eur J Clin Microbiol Infect Dis 20:864–870PubMedCrossRefGoogle Scholar
  14. 14.
    Marr KA, Carter RA, Crippa F, Wald A, Corey L (2002) Epidemiology and outcome of mould infections in hematopoetic stem cell transplant recipients. Clin Infect Dis 34:909–917PubMedCrossRefGoogle Scholar
  15. 15.
    Yeo SF, Wong B (2002) Current status of nonculture methods for diagnosis of invasive fungal infections. Clin Microbiol Rev 15:465–484PubMedCrossRefGoogle Scholar
  16. 16.
    Maertens J, Verhaegen J, Lagrou K, Van Elderle J, Boogaerts M (2001) Screening for circulating galactomannan as a noninvasive diagnostic tool for invasive aspergillosis in prolonged neutropenic patients and stem cell transplantation recipients: a prospective validation. Blood 97:1604–1610PubMedCrossRefGoogle Scholar
  17. 17.
    Verweij PE, Meis JF (2000) Microbiological diagnosis of invasive fungal infections in transplant recipients. Transpl Infect Dis 2:80–87PubMedCrossRefGoogle Scholar
  18. 18.
    Sendid B, Poirot JL, Tabouret M, Bonnin A, Caillot D, Camus D, Poulain D (2002) Combined detection of mannanaemia and antimannan antibodies as a strategy for the diagnosis of systemic infection caused by pathogenicCandida species. J Med Microbiol 51:433–442PubMedCrossRefGoogle Scholar
  19. 19.
    Wingard JR, Leather HA (2004) New era of antifungal therapy. Biol Blood Marrow Trans 10:73–90CrossRefGoogle Scholar
  20. 20.
    Mennink-Kersten MA, Donnelly JP, Verweij PE (2004) Detection of circulating galactomannan for the diagnosis and management of invasive aspergillosis. Lancet Infect Dis 4:349–357PubMedCrossRefGoogle Scholar
  21. 21.
    Pazos C, Pontón J, Del Palacio A (2005) Contribution of (1→3)-β-D-glucan chromogenic assay to diagnosis and therapeutic monitoring of invasive aspergillosis in neutropenic adult patients: a comparision with serial screening for circulating galactomannan. J Clin Microbiol 43:299–305PubMedCrossRefGoogle Scholar
  22. 22.
    Bardana EJ, Gerber JD, Craig S, Cianciulli FD (1975) The general and specific humoral immune response to pulmonary aspergillosis. Am Rev Resp Dis 112:799–805PubMedGoogle Scholar
  23. 23.
    Maertens J, Verhaegen J, Lagrou K (2002) Use of circulating galactomannan screening for early diagnosis of invasive aspergillosis in allogeneic stem cell transplant recipients. J Infect Dis 186:1297–1305PubMedCrossRefGoogle Scholar
  24. 24.
    Stevens D (2002) Diagnosis of fungal infections: current status. J Antimicrob Chemoth 49(Suppl S1):11–19Google Scholar
  25. 25.
    Verweij PE, Stynen D, Rijs AJ, de Pauw BE, Hoogkamp-Korstanje JA, Meis JF (1995) Sandwich enzyme-linked immunosorbent assay compared with Pastorex latex agglutination test for diagnosing invasive aspergillosis in immunocompromised patients. J Clin Microbiol 33:1912–1914PubMedGoogle Scholar
  26. 26.
    Stynen D, Goris A, Sarfati J, Latge JP (1995) A new sensitive sandwich enzyme-linked immunosorbent assay to detect galactofuran in patients with invasive aspergillosis. J Clin Microbiol 33:497–500PubMedGoogle Scholar
  27. 27.
    Ascioglu S, Rex JH, de Pauw B, Bennett JE, Bille J, Crokaert F, Denning DW, Donnelly JP, Edwards JE, Erjavec Z, Fiere D, Lortholary O, Maertens J, Meis JF, Patterson TF, Ritter J, Selleslag D, Shah PM, Stevens DA, Walsh TJ; Invasive Fungal Infections Cooperative Group of the European Organization for Research and Treatment of Cancer; Mycoses Study Group of the National Institute of Allergy and Infectious Diseases (2002) Defining opportunistic invasive fungal infection in immunocompromised patients with cancer and hematopoietic stem cell transplants: an international consensus. Clin Infect Dis 34:7–14PubMedCrossRefGoogle Scholar
  28. 28.
    Maertens JA, Klont R, Masson C, Theunissen K, Meersseman W, Lagrou K, Heinen C, Crepin B, Van Eldere J, Tabouret M, Donnelly JP, Verweij PE (2007) Optimization of the cutoff value for the aspergillus double-sandwich enzyme immunoassay. Clin Infect Dis 44:1329–1336PubMedCrossRefGoogle Scholar
  29. 29.
    Sulahian A, Boutboul F, Ribaud P, Leblanc T, Lacroix C, Derouin F (2001) Value of antigen detection using an enzyme immunoassay in the diagnosis and prediction of invasive aspergillosis in two adult and pediatric hematology units during a 4-year prospective study. Cancer 91:311–318PubMedCrossRefGoogle Scholar
  30. 30.
    Herbrecht R, Letscher-Bru V, Oprea C, Lioure B, Waller J, Campos F, Villard O, Liu K-L, Natarajan-Amé S, Lutz P, Dufour P, Bergerat J-P, Candolfi E (2002) Aspergillus galactomannan detection in the diagnosis of invasive aspergillosis in cancer patients. J Clin Oncol 20:1898–1906PubMedCrossRefGoogle Scholar
  31. 31.
    Pinel C, Fricker-Hidalgo H, Lebeau B, Garban F, Hamidfar R, Ambroise-Thomas P, Grillot R (2003) Detection of circulating Aspergillus fumigatus galactomannan: value and limits of the Platelia test for diagnosing invasive aspergillosis. J Clin Microbiol 41:2184–2186PubMedCrossRefGoogle Scholar
  32. 32.
    Verweij PE, Brinkman K, Kremer HP, Kullberg BJ, Meis JF (1999) Aspergillus meningitis: diagnosis by non-culture-based microbiological methods and management. J Clin Microbiol 37:1186–1189PubMedGoogle Scholar
  33. 33.
    Verweij PE, Erjavec Z, Sluiters W, Goessens W, Rozenbergarska M, Debets-Ossenkopp YJ, Guiot HFL, Meis JFGM, the Dutch Interuniversity Working Party for Invasive Mycoses (1998) Detection of antigen in sera of patients with invasive aspergillosis: intra- and interlaboratory reproducibility. J Clin Microbiol 36:1612–1616PubMedGoogle Scholar
  34. 34.
    Lai CC, Hsu HL, Lee LN, Hsueh PR (2007) Assessment of Platelia Aspergillus enzyme immunoassay for the diagnosis of invasive aspergillosis. J Microbiol Immunol Infect 40:148–153PubMedGoogle Scholar
  35. 35.
    Kami M, Tanaka Y, Kanda Y, Ogawa S, Masumoto T, Ohtomo K, Matsumura T, Saito T, Machida U, Kashima T, Hirai H (2000) Computed tomographic scan of the chest, latex agglutination test and plasma (1→3)-β-D-glucan assay in early diagnosis of invasive pulmonary aspergillosis: a prospective study of 215 patients. Haematologica 85:745–752PubMedGoogle Scholar
  36. 36.
    Ruhnke M, Böhme A, Buchheidt D, Donhuijsen K, Einsele H, Enzensberger R, Glasmacher A, Gumbel H, Heussel CP, Karthaus M, Lambrecht E, Sudhoff T, Szelenyi H, Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Oncology (DGHO) (2003) Diagnosis of invasive fungal infection in hematology and oncology. Ann Hematol 82(Suppl 2):141–148CrossRefGoogle Scholar
  37. 37.
    Maertens J, Theunissen K, Verhoef G, Verschakelen J, Lagrou K, Verbeken E, Wilmer A, Verhaegen J, Boogaerts M, van Eldere J (2005) Galactomannan and computed tomography-based preemptive antifungal therapy in neutropenic patients at high risk for invasive fungal infection: a prospective feasibility study. Clin Infect Dis 41:1242–1250PubMedCrossRefGoogle Scholar
  38. 38.
    Shao PL, Huang LM, Hsueh PR (2006) Invasive fungal infection - laboratory diagnosis and antifungal treatment. J Microbiol Immunol Infect 39:178–188PubMedGoogle Scholar
  39. 39.
    Sendid B, Tabouret M, Poirot JL, Mathieu D, Fruit J, Poulain D (1999) New enzyme immunoassays for sensitive detection of circulatingCandida albicans mannan and antimannan antibodies: useful combined test for diagnosis of systemic candidiasis. J Clin Microbiol 37:1510–1517PubMedGoogle Scholar
  40. 40.
    Sendid B, Caillot D, Baccouch-Humbert B, Klingspor L, Grandjean M, Bonnin A, Poulain D (2003) Contribution of the Platelia Candida-specific antibody and antigen tests to early diagnosis of systemicCandida tropicalis infection in neutropenic adults. J Clin Microbiol 41:4551–4558PubMedCrossRefGoogle Scholar
  41. 41.
    Weiner MH, Coats-Stephen M (1979) Immunodiagnosis of systemic candidiasis: mannanemia detected by radioimmunoassay in experimental and human infections. J Infect Dis 140:989–993PubMedGoogle Scholar
  42. 42.
    Fujita S, Takamura T, Nagahara M, Hashimoto T (2006) Evaluation of a newly developed down-flow immunoassay for detection of serum mannan antigens in patients with candidaemia. J Med Microbiol 55:537–543PubMedCrossRefGoogle Scholar
  43. 43.
    Verduyn Lunel FM, Voss A, Kuijper EJ, Gelinck LB, Hoogerbrugge PM, Liem KL, Kullberg BJ, Verweij PE (2004) Detection of theCandida antigen mannan in cerebrospinal fluid specimens from patients suspected of havingCandida meningitis. J Clin Microbiol 42:867–870PubMedCrossRefGoogle Scholar
  44. 44.
    Odabasi Z, Mattiuzzi G, Estey E, Kantarjian H, Saeki F, Ridge RJ, Ketchum PA, Finkelman MA, Rex JH, Ostrosky-Zeichner L (2004) β-D-Glucan as a diagnostic adjunct for invasive fungal infections: validation, cutoff development, and performance in patients with acute myelogenous leukemia and myelodysplastic syndrome. Clin Infect Dis 39:199–205PubMedCrossRefGoogle Scholar
  45. 45.
    Ostrosky-Zeichner L, Alexander BD, Kett DH, Vazquez J, Pappas PG, Saeki F, Ketchum PA, Wingard J, Schiff R, Tamura H, Finkelman MA, Rex JH (2005) Multicenter clinical evaluation of (1→3)-β-D-glucan assay as an aid to diagnosis of fungal infections in humans. Clin Infect Dis 41:654–659PubMedCrossRefGoogle Scholar
  46. 46.
    Takebayashi H, Mizota A, Tanaka M (2005) Relation between stage of endogenous fungal endophthalmitis and prognosis. Graefe’s Arch Clin Exp Ophthalmol 6:1–5Google Scholar
  47. 47.
    Miyazaki T, Kohno S, Mitsutake K, Maesaki S, Tanaka K, Ishikawa N, Hara K (1995) Plasma (1→3)-β-D-glucan and fungal antigenemia in patients with candidemia, aspergillosis, and cryptococcosis. J Clin Microbiol 33:3115–3118PubMedGoogle Scholar
  48. 48.
    Horiguchi Y (2004) The performance of (1, 3)-beta-D-glucan andAspergillus galactomannan measurement for early diagnosis of invasive aspergillosis in patients with hematological diseases. Kansenshogaku Zasshi 78:566–573PubMedGoogle Scholar
  49. 49.
    Kondori N, Edebo L, Mattsby-Baltzer I (2004) Circulating β (1–3) glucan and immunoglobulin G subclass antibodies toCandida albicans cell wall antigens in patients with systemic candidiasis. Clin Diagn Lab Immunol 11:344–350PubMedCrossRefGoogle Scholar
  50. 50.
    Yasuoka A, Tachikawa N, Shimada K, Kiura S, Oka S (1996) (1→3) β-D-Glucan as a quantitative serological marker for Pneumocystis carinii pneumonia. Clin Diagn Lab Immunol 3:197–199PubMedGoogle Scholar
  51. 51.
    Yuasa K, Goto H, Iguchi M, Okamura T, Ieki R (1996) Evaluation of the diagnostic value of the measurement of (1→3)-beta-D-glucan in patients with pulmonary aspergillosis. Respiration 63:78–83PubMedGoogle Scholar
  52. 52.
    Yoshida M, Obayashi T, Iwama A, Ito M, Tsunoda S, Suzuki T, Muroi K, Ohta M, Sakamoto S, Miura Y (1997) Detection of plasma (1–3)-beta-D-glucan in patients with Fusarium, Trichosporon, Saccharomyces, and Acremonium fungaemias. J Med Vet Mycol 35:371–374PubMedCrossRefGoogle Scholar
  53. 53.
    Moro H, Tsukada H, Ohara T, Susa R, Tanabe Y, Suzuki E, Gejyo F (2003) Comparision of four diagnostic methods using clinical blood by measuring (1→3)-beta-D-glucan. Kansenshogaku Zasshi 77:227–234PubMedGoogle Scholar
  54. 54.
    Hossain MA, Miyazaki T, Mitsutake K, Kakeya H, Yamamoto Y, Yanagihara K, Kawamura S, Otsubo T, Hirakata Y, Tashiro T, Kohno S (1997) Comparision between Wako-WB003 and Fungitec G tests for detection of (1→3)-beta-D-glucan in systemic mycosis. Clin Lab Anal 11:73–77CrossRefGoogle Scholar
  55. 55.
    Upton A, Leisenring W, Marr KA (2006) (1→3) beta-D-glucan assay in the diagnosis of invasive fungal infections. Clin Infect Dis 42:1054–1056PubMedCrossRefGoogle Scholar
  56. 56.
    Uchiyama M, Ohno N, Miura NN, Adachi Y, Aizawa MW, Tamura H, Tanaka S, Yadomae T (1999) Chemical and immunochemical characterization of limulus factor G-activating substance ofCandida spp. FEMS Immunol Med Microbiol 4:411–420CrossRefGoogle Scholar
  57. 57.
    Obayashi T, Yoshida M, Mori T, Goto H, Yasuoka A, Iwasaki H, Teshima H, Kohno S, Horiuchi A, Ito A, Yamaguchi H, Shimada K, Kawai T (1995) Plasma (1→3)-β-D-glucan measurement in diagnosis of invasive deep mycosis and fungal febrile episodes. Lancet 345:17–20PubMedCrossRefGoogle Scholar
  58. 58.
    Digby J, Kalbfleisch J, Glenn A, Larsen A, Browder W, Williams D (2003) Serum glucan are not specific for presence of fungal infections in intensive care unit patients. Clin Diagn Lab Immunol 10:882–885PubMedCrossRefGoogle Scholar
  59. 59.
    Miura NN, Adachi Y, Yadomae T, Tamura H, Tanaka S, Ohno N (2003) Structure and biological activities of β-glucans from yeast and mycelial forms ofCandida albicans. Microbiol Immunol 47:173–182PubMedGoogle Scholar
  60. 60.
    Takesue Y (2004) Strategy for the treatment of fungal infections in critically ill surgical patients. Nippon Ishinkin Gakkai Zasshi 45:217–221PubMedGoogle Scholar
  61. 61.
    Aibiki M, Ohtsubo S, Nishiyama T, Maekawa S, Oka H, Dote K, Shirakawa Y (2005) Elevated serum beta-D-glucan level and depressed neutrophil phagocytosis in a heatstroke patient. Resuscitation 65:115–117PubMedCrossRefGoogle Scholar
  62. 62.
    Imai K, Ashitani J, Imazu Y, Yanagi S, Sano A, Tokojima A, Nakazato M (2004) Farmer’s lung casus of a farmer and his son with high BAL fluid beta-D glucan levels. Nihon Kokyuki Gakkai Zasshi 42:1024–1029PubMedGoogle Scholar
  63. 63.
    Verweij PE, Weemaes CM, Curfs JH, Bretagne S, Meis JF (2000) Failure to detect circulatingAspergillus markers in a patient with chronic granulomatous disease and invasive aspergillosis. J Clin Microbiol 38:3900–3901PubMedGoogle Scholar
  64. 64.
    Nagasawa K, Yano T, Kitabayashi G, Morimoto H, Yamada Y, Ohata A, Usami M, Horiuchi T (2003) Experimental proof of contamination of blood components by (1→3)-β-D-glucan caused by filtration with cellulose filters in the manufacturing process. J Artif Organs 6:49–54PubMedCrossRefGoogle Scholar
  65. 65.
    Walsh TJ, Shoham S, Petraitiene R, Sein T, Schaufele R, Kelaher A, Murray H, Mya-San C, Bacher J, Petraitis V (2004) Detection of galactomannan antigenemia in patients receiving piperacillin-tazobactam and correlations between in vitro, in vivo, and clinical properties of the drug-antigen interaction. J Clin Microbiol 42:4744–4748PubMedCrossRefGoogle Scholar
  66. 66.
    Mennink-Kersten MA, Klont RR, Warris Aop den Camp HJ, Verweij PE (2004) Bifidobacterium lipoteichoic acid and false ELISA reactivity in aspergillus antigen detection. Lancet 363:325–327PubMedCrossRefGoogle Scholar
  67. 67.
    Swanink C, Meis J, Rijs A, Donnelly JP, Verweij PE (1997) Specificity of a sandwich enzyme-linked immunosorbent assay for detecting aspergillus galactomannan. J Clin Microbiol 35:257–260PubMedGoogle Scholar
  68. 68.
    Gangneux JP, Lavarde D, Bretagne S, Gniguen C, Gandemer V (2002) Transient Aspergillus antigenemia: think of milk. Lancet 359:1251PubMedCrossRefGoogle Scholar
  69. 69.
    Denning DW (2000) Early diagnosis of invasive aspergillosis. Lancet 355:423–424PubMedGoogle Scholar
  70. 70.
    Usami M, Ohata T, Horiuchi T, Nagasawa K, Wakabayashi T, Tanaka S (2002) Positive (1→3) β-D-glucan in blood components and release of (1→3) β-D-glucan from depth-type membrane filters for blood processing. Transfusion 42:1189–1195PubMedCrossRefGoogle Scholar
  71. 71.
    Kanda H, Kubo K, Hamasaki K, Kanda Y, Nakao A, Kitamura T, Fujita T, Yamamoto K, Mimura T (2001) Influence of various hemodialysis membranes on the plasma (1→3)-β-D-glucan level. Kidney Int 60:319–323PubMedCrossRefGoogle Scholar
  72. 72.
    Nakao A, Yasui M, Kawagoe T, Tamura H, Tanaka S, Takagi H (1997) False-positive endotoxemia derives from gauze glucan after hepatectomy for hepatocellular carcinoma a with cirrhosis. Hepatogastroenterology 44:1413–1418PubMedGoogle Scholar
  73. 73.
    Vassallo R (1999) Fungal β-glucan can yield false-positive results with the limulus amebocyte lysate endotoxin assay. Chest 116:583–584PubMedCrossRefGoogle Scholar
  74. 74.
    Kawai R, Igarashi K, Yoshida M, Kitaoka M, Samejima M (2006) Hydrolysis of β-1,3/1,6-glucan by glycoside hydrolase family 16 endo-1,3(4)-β-glucanase from the basidiomycete Phanerochaete chrysosporium. Appl Microbiol Biotechnol 71:898–906PubMedCrossRefGoogle Scholar
  75. 75.
    Ishizuka Y, Tsukada H, Gejyo F (2004) Interference of (1.3)-β-D-glucan administration in the measurement of plasma (1.3)-β-D-glucan. Int Med 43:97–101CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • A. Kędzierska
    • 1
  • P. Kochan
    • 2
  • A. Pietrzyk
    • 2
  • J. Kędzierska
    • 3
  1. 1.Department of Clinical Microbiology, Chair of Clinical Immunology and Transplantology, Polish-American Institute of PaediatricsJagiellonian University Medical CollegeCracowPoland
  2. 2.Chair of MicrobiologyJagiellonian University Medical CollegeCracowPoland
  3. 3.Department of Diagnostics, Laboratory of MicrobiologyUniversity HospitalCracowPoland

Personalised recommendations