Introducing 1,3‐beta‐<scp>d</scp>‐glucan for screening and diagnosis of invasive fungal diseases in Australian high‐risk haematology patients: is there a clinical benefit?

Garnham, Katherine; Halliday, Catriona; Joshi, Neela P.; Jayawadena, Menuk; Hasan, Tasnim; Kok, Jen; Nayyar, Vineet; Gottlieb, David; Gilroy, Nicole; Chen, Sharon C‐A

doi:10.1111/imj.15046

Cited by 9 publications

(9 citation statements)

References 63 publications

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“…Australian data on the utility of serum BDG assay are sparse. The Fungitell assay performance for the diagnosis (or exclusion) of IFD in haematology patients receiving mould‐active prophylaxis from a single institution, suggests suboptimal sensitivity and PPV for the diagnosis of any IFD 119 …”

Section: Question 4: How May Biomarkers For Aspergillosis Be Utilised To Establish Diagnosis and To Pre‐emptively Screen For Ia?mentioning

confidence: 99%

“…The Fungitell assay performance for the diagnosis (or exclusion) of IFD in haematology patients receiving mould-active prophylaxis from a single institution, suggests suboptimal sensitivity and PPV for the diagnosis of any IFD. 119 There are few data on yield of BDG performed on BAL fluid. A single-centre study performed on patients with pulmonary infiltrates found modest sensitivity and specificity (56.5% and 83.2% respectively) but with poor PPV (34.2%).…”

Section: 3-β-d-glucanmentioning

confidence: 99%

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Consensus guidelines for the diagnosis and management of invasive aspergillosis, 2021

Douglas

Smibert

Bajel

et al. 2021

Internal Medicine Journal

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Invasive aspergillosis (IA) in haematology/oncology patients presents as primary infection or breakthrough infection, which can become refractory to antifungal treatment and has a high associated mortality. Other emerging patient risk groups include patients in the intensive care setting with severe respiratory viral infections, including COVID‐19. These guidelines present key diagnostic and treatment recommendations in light of advances in knowledge since the previous guidelines in 2014. Culture and histological‐based methods remain central to the diagnosis of IA. There is increasing evidence for the utility of non‐culture methods employing fungal biomarkers in pre‐emptive screening for infection, as well as for IA diagnosis when used in combination. Although azole resistance appears to be uncommon in Australia, susceptibility testing of clinical Aspergillus fumigatus complex isolates is recommended. Voriconazole remains the preferred first‐line antifungal agent for treating primary IA, including for extrapulmonary disease. Recommendations for paediatric treatment broadly follow those for adults. For breakthrough and refractory IA, a change in class of antifungal agent is strongly recommended, and agents under clinical trial may need to be considered. Newer immunological‐based imaging modalities warrant further study, while surveillance for IA and antifungal resistance remain essential to informing the relevance of current treatment recommendations.

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Section: Question 4: How May Biomarkers For Aspergillosis Be Utilised To Establish Diagnosis and To Pre‐emptively Screen For Ia?mentioning

confidence: 99%

Section: 3-β-d-glucanmentioning

confidence: 99%

Consensus guidelines for the diagnosis and management of invasive aspergillosis, 2021

Douglas

Smibert

Bajel

et al. 2021

Internal Medicine Journal

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“…When setting a cutoff value of 80 pg/mL for serum β-dglucan (9 studies [100][101][102][103][104][105][106][107][108]: N = 757), the integrated sensitivity was 0.70 (95% CI: 0.49-0.85) and the integrated specificity was 0.73 (95% CI: 0.58-0.84). Additionally, when setting a cutoff value of 1.0 optical density index (ODI) for blood galactomannan antigen tests (8 studies [109][110][111][112][113][114][115][116]: N = 145), the integrated sensitivity was 0.76 (95% CI: 0.60-0.91) and the integrated specificity was 0.88 (95% CI: 0.79-0.94).…”

Section: Summary Of Evidencementioning

confidence: 99%

ARDS Clinical Practice Guideline 2021

et al. 2022

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Background The joint committee of the Japanese Society of Intensive Care Medicine/Japanese Respiratory Society/Japanese Society of Respiratory Care Medicine on ARDS Clinical Practice Guideline has created and released the ARDS Clinical Practice Guideline 2021. Methods The 2016 edition of the Clinical Practice Guideline covered clinical questions (CQs) that targeted only adults, but the present guideline includes 15 CQs for children in addition to 46 CQs for adults. As with the previous edition, we used a systematic review method with the Grading of Recommendations Assessment Development and Evaluation (GRADE) system as well as a degree of recommendation determination method. We also conducted systematic reviews that used meta-analyses of diagnostic accuracy and network meta-analyses as a new method. Results Recommendations for adult patients with ARDS are described: we suggest against using serum C-reactive protein and procalcitonin levels to identify bacterial pneumonia as the underlying disease (GRADE 2D); we recommend limiting tidal volume to 4–8 mL/kg for mechanical ventilation (GRADE 1D); we recommend against managements targeting an excessively low SpO2 (PaO2) (GRADE 2D); we suggest against using transpulmonary pressure as a routine basis in positive end-expiratory pressure settings (GRADE 2B); we suggest implementing extracorporeal membrane oxygenation for those with severe ARDS (GRADE 2B); we suggest against using high-dose steroids (GRADE 2C); and we recommend using low-dose steroids (GRADE 1B). The recommendations for pediatric patients with ARDS are as follows: we suggest against using non-invasive respiratory support (non-invasive positive pressure ventilation/high-flow nasal cannula oxygen therapy) (GRADE 2D), we suggest placing pediatric patients with moderate ARDS in the prone position (GRADE 2D), we suggest against routinely implementing NO inhalation therapy (GRADE 2C), and we suggest against implementing daily sedation interruption for pediatric patients with respiratory failure (GRADE 2D). Conclusions This article is a translated summary of the full version of the ARDS Clinical Practice Guideline 2021 published in Japanese (URL: https://www.jsicm.org/publication/guideline.html). The original text, which was written for Japanese healthcare professionals, may include different perspectives from healthcare professionals of other countries.

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“…In a recent prospective Australian experience of BDG screening of 57 episodes in 52 haematology patients at high risk of IFD, eight episodes of proven/probable IFD and 18 episodes of possible IFD were diagnosed [36]. Most of the patients received antifungals, either in prophylaxis or treatment.…”

Section: Bdg In Diagnosis Of Invasive Candidiasis and Invasive Asperg...mentioning

confidence: 99%

“…Overall, BDG resulted positive in 32% of samples, but the sensitivity of BDG for proven/probable IFD was only 5/8 for a single positive sample and 3/8 for two consecutive positive samples, while BDG was positive in the absence of IFD (false positive) in 8/11 episodes. The reasons for such a poor performance remain unknown, with cyclosporine and methotrexate therapy found associated with false positive results, possibly due to circulating endogenous glucans from increased gut permeability [36]. Low sensitivity could be influenced by the high percentage of patients (63.2%) receiving antimould-active antifungal agents, including all patients who developed proven/probable IFDs.…”

Section: Bdg In Diagnosis Of Invasive Candidiasis and Invasive Asperg...mentioning

confidence: 99%

Beta-D-Glucan in Patients with Haematological Malignancies

Mikulska

Balletto

Castagnola

et al. 2021

JoF

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(1-3)-beta-D-glucan (BDG) is an almost panfungal marker (absent in zygomycetes and most cryptococci), which can be successfully used in screening and diagnostic testing in patients with haematological malignancies if its advantages and limitations are known. The aim of this review is to report the data, particularly from the last 5 years, on the use of BDG in haematological population. Published data report mainly on the performance of the Fungitell™ assay, although several others are currently available, and they vary in method and cut-off of positivity. The sensitivity of BDG for invasive fungal disease (IFD) in haematology patients seems lower than in other populations, possibly because of the type of IFD (lower sensitivity was found in case of aspergillosis compared to candidiasis and pneumocystosis) or the use of prophylaxis. The specificity of the test can be improved by using two consecutive positive assays and avoiding testing in the case of the concomitant presence of factors associated with false positive results. BDG should be used in combination with clinical assessment and other diagnostic tests, both radiological and mycological, to provide maximum information. Good performance of BDG in cerebrospinal fluid (CSF) has been reported. BDG is a useful diagnostic method in haematology patients, particularly for pneumocystosis or initial diagnosis of invasive fungal infections.

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Introducing 1,3‐beta‐d‐glucan for screening and diagnosis of invasive fungal diseases in Australian high‐risk haematology patients: is there a clinical benefit?

Cited by 9 publications

References 63 publications

Consensus guidelines for the diagnosis and management of invasive aspergillosis, 2021

Consensus guidelines for the diagnosis and management of invasive aspergillosis, 2021

ARDS Clinical Practice Guideline 2021

Beta-D-Glucan in Patients with Haematological Malignancies

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