PDF(Pubmed)
Abstract：
Multidrug resistant strains and fungi add to treatment conundrums in skull base osteomyelitis (SBO). Deep tissue culture in these patients is challenging due to their advanced age and co-morbidities. Besides, fungal culture positivity is seen only in 60% of invasive aspergillosis. To determine the efficacy of a minimally invasive test-Serum Galactomannan (sGM)-for diagnosing fungal SBO. Prospective observational study. Thirty- three patients, clinically diagnosed with SBO were included in this study. Baseline ESR (Erythrocyte Sedimentation Rate), CRP (C- Reactive Protein), pain score, and sGM were noted for all patients. Antifungal Voriconazole was initiated on patients if the sGM values were more than 0.8. At the 12th week of treatment, all parameters were repeated and compared with the baseline values. A significant reduction was noted in ESR, CRP, and pain scores at the 12th week of treatment compared to the baseline values in patients with raised sGM values who were started on Voriconazole. For a culture-proven fungal skull base osteomyelitis with a cut-off value of sGM > / = 0.8, the obtained sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were 81.82, 36.36, 39.13, 80 and 51.52% respectively. At a cut-off value of sGM > / = 01.6, the values of sensitivity/specificity, PPV, NPV and accuracy were 81.82/72.73%, 60%, 88.89% and 75.76%. Culture-negative patients in SBO with sGM value > 0.8 were more likely to be fungal SBO. An sGM cut-off of 1.6 was observed to give maximum accuracy for diagnosing fungal SBO.
摘要：
多重耐药菌株和真菌增加了颅底骨髓炎（SBO）的治疗难题。由于这些患者的高龄和合并症，深层组织培养具有挑战性。此外,真菌培养阳性仅在60％的侵袭性曲霉病中可见。确定微创测试-血清半乳甘露聚糖（sGM）-诊断真菌SBO的功效。前瞻性观察性研究。33名患者，本研究包括临床诊断为SBO的患者。基线ESR（红细胞沉降率），CRP(C-反应蛋白),疼痛评分,所有患者均记录sGM。如果sGM值大于0.8，则对患者开始使用抗真菌伏立康唑。在治疗的第12周，重复所有参数并与基线值进行比较.ESR显著下降，CRP,与开始服用伏立康唑的sGM值升高的患者的基线值相比，治疗12周时的疼痛评分。对于培养证实的真菌性颅底骨髓炎，其临界值为sGM>/=0.8，获得的灵敏度，特异性，阳性预测值(PPV)，负预测值(NPV)，准确度分别为81.82、36.36、39.13、80和51.52%。在sGM>/=01.6的截止值时，灵敏度/特异性值，PPV,净现值和准确率分别为81.82/72.73%，60%,88.89%和75.76%。sGM值>0.8的SBO中培养阴性患者更可能是真菌SBO。观察到1.6的sGM截止值以提供诊断真菌SBO的最大准确性。
