Performance of 1,3‐beta‐D‐glucan in the diagnosis and monitoring of invasive fusariosis

Abstract

Summary Invasive fusariosis (IF) usually presents with high fungal burden at diagnosis, and this may contribute to its high mortality rate. The use 1,3‐beta‐D‐glucan (BDG) may help to establish the diagnosis at an earlier disease stage and to monitor treatment. To evaluate the performance of BDG in the diagnosis of IF and its kinetics in relation to the outcome, we retrospectively tested serum samples of 13 cases of IF, analysed the temporal relationship between the first positive BDG test and the date of the diagnosis of IF, and the kinetics of BDG in relation to patients’ outcome. We selected 13 controls with similar underlying diseases as cases, at least two serum samples stored, and no invasive fungal disease. Twelve patients with IF had at least one positive BDG (median 4, range 1‐16). The test was positive before the diagnosis of IF in 11 of the 12 patients (91.6%), at a median of 10 days (range 1‐32). The median BDG value increased (from 109 to 316 pg/mL, P = 0.04) in patients who died by day 30, and did not change significantly (99‐101 pg/mL, P = 0.60) in survivors. Using two consecutive BDG tests, sensitivity, specificity, and positive and negative predictive values were 85%, 69%, 7% and 99%, respectively. BDG is positive in the majority of patients with IF, usually before the diagnosis, but the low positive predictive value limits its use to diagnose IF earlier. Once therapy is started, decreasing BDG values suggests treatment response.

Therapeutic Challenges of Non- Aspergillus Invasive Mold Infections in Immunosuppressed Patients

“…A similar sensitivity has been observed for the beta-glucan test (137). Both markers were found to anticipate diagnosis of fusariosis by cultures by several days (136,137), which may be crucial for prompt initiation of antifungal therapy and possibly improved outcomes. The role of serum biomarkers for the diagnosis of other NAIMIs is unclear because of lacking data.…”

“…and was found to have a sensitivity of 83% for the detection of invasive fusariosis (136). A similar sensitivity has been observed for the beta-glucan test (137). Both markers were found to anticipate diagnosis of fusariosis by cultures by several days (136,137), which may be crucial for prompt initiation of antifungal therapy and possibly improved outcomes.…”

Biomarkers of fungal infection: Expert opinion on the current situations

“…Nucci et al [41] have recently provided interesting data on the use of 1-3-ßDG in the diagnosis and prognosis tory as it almost never allows "real time" determination due to the need of batching serums for joint processing. It is also a long (approx.…”

Systemic Fusariosis: A Rare Complication in Children with Acute Lymphoblastic Leukemia

“…At that time, diagnosis of Aspergillus pneumonia was not confirmed, even by histology. BDG can be helpful for establishing the diagnosis at an early disease stage and to monitor the response to treatment for invasive mycoses such as Aspergillus, Candida, and Fusarium [10][11][12], as observed in patient 1. GM presents a cross-reactivity with antigens released by a large number of fungi, as reported in the literature [13,14].…”