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Abstract Details

CSF (1,3) b-D-glucan as an adjunctive test for invasive CNS fungal infection due to presumed Exserohilum rostratum
Infections/AIDS/Prion Disease
(-)
003
From May - September 2012, over 14,000 patients who underwent epidural steroid injection were exposed to methylprednisolone acetate from lots contaminated with environmental fungi. Many patients developed serious central nervous system complications, but definitive fungal identification has been elusive. Whereas BG detection in serum can assist in diagnosis of systemic fungal infection, its utility as a CSF assay is unknown.
BG was quantified via Fungitell® assay at Beacon Diagnostic Laboratories (East Falmouth, MA) from CSF of 6 patients who were exposed to the implicated medication but whose fungal cultures and polymerase chain reactions were negative. 4 fit CDC case definitions for probable meningitis. 2 did not fit criteria but underwent lumbar puncture due to exposure history in the setting of clinical illness.
All 4 probable meningitis cases had detectable CSF BG. One of the cases had two samples separated by 2 weeks during which she was treated and showed symptomatic resolution with voriconazole, and the titer decreased from the first to the second test. Both cases not fitting criteria for probable meningitis had undetectable CSF BG, and clinically their presentations were thought to be due to other causes.
Establishing the diagnosis of fungal meningitis in the current nationwide outbreak has been difficult, and little is known about the natural history of this disease or therapeutic responses. Measurement of CSF BG may be a useful adjunctive test for the diagnosis and therapeutic monitoring of fungal meningitis during an outbreak or for culture-negative cases. Additionally, sequential quantification could be useful for determination of therapy duration, but more data would be necessary to understand the anticipated kinetics of antigen positivity and relationship to suspected disease.
Authors/Disclosures
Jennifer Lyons, MD (Brigham and Women's Hospital) Dr. Lyons has received personal compensation for serving as an employee of Biogen. Dr. Lyons has received stock or an ownership interest from Biogen.
Kiran Thakur, MD, FAAN (Columbia University College of Physicians and Surgeons) Dr. Thakur has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Delve Bio. The institution of Dr. Thakur has received research support from Center for Disease Control and Prevention.
Dorlan J. Kimbrough, MD (Duke University) Dr. Kimbrough has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for CVS.
Bryan Smith, MD (NIH) Dr. Smith has nothing to disclose.
Farrah J. Mateen, MD, PhD, FAAN (Massachusetts General Hospital) Dr. Mateen has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Horizon Therapeutics (Amgen). Dr. Mateen has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. Dr. Mateen has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for EMD Serono. Dr. Mateen has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Neurology. The institution of Dr. Mateen has received research support from Genentech. The institution of Dr. Mateen has received research support from EMD Serono. The institution of Dr. Mateen has received research support from Novartis. The institution of Dr. Mateen has received research support from Horizon Therapeutics (Amgen). The institution of Dr. Mateen has received research support from TG Therapeutics. Dr. Mateen has received intellectual property interests from a discovery or technology relating to health care.
No disclosure on file
No disclosure on file
Karen L. Roos, MD, FAAN No disclosure on file
Ralph H. Benedict, PhD (University At Buffalo) Dr. Benedict has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Novartis. Dr. Benedict has received personal compensation in the range of $50,000-$99,999 for serving as a Consultant for Roche. Dr. Benedict has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Sanofi. Dr. Benedict has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Biogen. Dr. Benedict has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Bristol Meyers Squibb. Dr. Benedict has received personal compensation in the range of $50,000-$99,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche. Dr. Benedict has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Biogen. Dr. Benedict has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Brystal Mier Squibb. Dr. Benedict has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for EMD Serono. The institution of Dr. Benedict has received research support from Genzyme. The institution of Dr. Benedict has received research support from Biogen. The institution of Dr. Benedict has received research support from Bristol Myer Squib. Dr. Benedict has received intellectual property interests from a discovery or technology relating to health care.