(1→3)-β-D-glucan testing for the detection of invasive fungal infections in immunocompromised or critically ill people

White, Sandra; Schmidt, Robert L.; Walker, Brandon S; Hanson, Kimberly E.

doi:10.1002/14651858.cd009833.pub2

Cited by 25 publications

(21 citation statements)

References 136 publications

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“…However, it may be mentioned that BDG was elevated in all patients with probable IA. Additionally, our results are in line with previously published results showing a very wide sensitivity range of the Fungitell assay (27% to 100%) [ 31 ].…”

Section: Discussionsupporting

confidence: 93%

“…In contrast to sensitivity, the results for specificity are based on 23 patients and more than 380 serum samples. The specificity of a single positive BDG value was only moderate but again falls into the previously published specificity range of 0% to 100% [ 31 ]. So far, only one study investigated the performance of BDG with a focus on IA in pediatric patients [ 3 ].…”

Section: Discussionsupporting

confidence: 60%

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Diagnostic Performance of (1→3)-β-D-Glucan Alone and in Combination with Aspergillus PCR and Galactomannan in Serum of Pediatric Patients after Allogeneic Hematopoietic Stem Cell Transplantation

Springer

Held

Mengoli

et al. 2021

JoF

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Data on biomarker-assisted diagnosis of invasive aspergillosis (IA) in pediatric patients is scarce. Therefore, we conducted a cohort study over two years including 404 serum specimens of 26 pediatric patients after allogeneic hematopoietic stem cell transplantation (alloSCT). Sera were tested prospectively twice weekly for Aspergillus-specific DNA, galactomannan (GM), and retrospectively for (1→3)-β-D-glucan (BDG). Three probable IA and two possible invasive fungal disease (IFD) cases were identified using the European Organization for Research and Treatment of Cancer and the Mycoses Study Group (EORTC/MSGERC) 2019 consensus definitions. Sensitivity and specificity for diagnosis of probable IA and possible IFD was 80% (95% confidential interval (CI): 28–99%) and 55% (95% CI: 32–77%) for BDG, 40% (95% CI: 5–85%) and 100% (95% CI: 83–100%) for GM, and 60% (95% CI: 15–95%) and 95% (95% CI: 75–100%) for Aspergillus-specific real-time PCR. However, sensitivities have to be interpreted with great caution due to the limited number of IA cases. Interestingly, the low specificity of BDG was largely caused by false-positive BDG results that clustered around the date of alloSCT. The following strategies were able to increase BDG specificity: two consecutive positive BDG tests for diagnosis (specificity 80% (95% CI: 56–94%)); using an optimized cutoff value of 306 pg/mL (specificity 90% (95% CI: 68–99%)) and testing BDG only after the acute posttransplant phase. In summary, BDG can help to diagnose IA in pediatric alloSCT recipients. However, due to the poor specificity either an increased cutoff value should be utilized or BDG results should be confirmed by an alternative Aspergillus assay.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 60%

Diagnostic Performance of (1→3)-β-D-Glucan Alone and in Combination with Aspergillus PCR and Galactomannan in Serum of Pediatric Patients after Allogeneic Hematopoietic Stem Cell Transplantation

Springer

Held

Mengoli

et al. 2021

JoF

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“…In the present study, 3 of 5 patients with proven IFD and antifungal treatment had GT values below 4.1 pg/ml. According to a recently published Cochrane systematic review that included 49 studies with a total of 6244 participants, it is not possible to estimate the diagnostic accuracy of the BDG for detecting IFD in immunocompromised or critically ill patients due to wide variation in the results for both, sensitivity and specificity 27 . An exception, however, are patients with PCP.…”

Section: Discussionmentioning

confidence: 99%

Clinical evaluation of two different (1,3)‐ß‐d‐glucan assays for diagnosis of invasive fungal diseases: A retrospective cohort study

Zubkowicz

Held

Baier

et al. 2020

Mycoses

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BackgroundEarly diagnosis of invasive fungal diseases (IFDs) remains a major challenge in routine clinical practice.ObjectivesThe aim of this retrospective cohort study was to evaluate the diagnostic performance of the fungal biomarker (1,3)‐ß‐d‐glucan (BDG) using the β‐Glucan test (GT) and the well‐established Fungitell assay® (FA) in real‐life clinical practice.Patients/MethodsWe included 109 patients with clinical suspicion of IFD who were treated at Jena University Hospital, Germany, between November 2018 and March 2019. The patients were classified according to the latest update of the EORTC/MSG consensus definitions of IFD. The first serum sample of every patient was analysed for BDG using the FA and the GT, respectively.ResultsFifty‐six patients (51.4%) had at least one host factor for IFD. In patients with proven (n = 11) or probable IFDs (n = 20), median BDG concentrations were 145.0 pg/ml for the FA and 5.1 pg/ml for the GT, respectively. A positive test result of both BDG assays at manufacturer's cut‐offs predicted 89.5%‐98.3% of proven or probable IFD, but the sensitivity of both assays was limited: The FA identified 60.7% of IFDs (cut‐off: 80 pg/ml). Reducing the GT cut‐off value from 11.0 to 4.1 pg/ml increased the detection rate of IFDs from 35.5% to 54.8%.ConclusionsA positive test result of both BDG assays at manufacturer's cut‐off was highly predictive for IFD, but except for Pneumocystis jirovecii pneumonia sensitivities were limited. Adjustment of the GT cut‐off value equalised sensitivities of GT and FA.

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“…Pneumocystis jiroveci [34]. Sensitivity and specificity depend on fungal pathogens and underlying patient populations examined [35]. Various colorimetric and turbidimetric assays J o u r n a l P r e -p r o o f are available, see Table 3.…”

Section: Resultsmentioning

confidence: 99%

Serology anno 2021—fungal infections: from invasive to chronic

Lass‐Flörl

Samardzic

Knoll

2021

Clinical Microbiology and Infection

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(1→3)-β-D-glucan testing for the detection of invasive fungal infections in immunocompromised or critically ill people

Cited by 25 publications

References 136 publications

Diagnostic Performance of (1→3)-β-D-Glucan Alone and in Combination with Aspergillus PCR and Galactomannan in Serum of Pediatric Patients after Allogeneic Hematopoietic Stem Cell Transplantation

Diagnostic Performance of (1→3)-β-D-Glucan Alone and in Combination with Aspergillus PCR and Galactomannan in Serum of Pediatric Patients after Allogeneic Hematopoietic Stem Cell Transplantation

Clinical evaluation of two different (1,3)‐ß‐d‐glucan assays for diagnosis of invasive fungal diseases: A retrospective cohort study

Serology anno 2021—fungal infections: from invasive to chronic

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