Diagnosis of Invasive Aspergillosis (see Aspergillus, [[Aspergillus]])
Recommendations (Infectious Diseases Society of America 2016 Practice Guidelines) (Clin Infect Dis, 2016) [MEDLINE]
Serum (1–3)-β-D-Glucan is Recommended for Diagnosing Invasive Aspergillus in High-Risk Patients (Hematologic Malignancy, Hematopoietic Stem Cell Transplant), But is Notably Not Specific for Aspergillus (Strong Recommendation, Moderate-Quality Evidence)
Diagnosis of Candidal Infection (see Candida, [[Candida]])
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Diagnosis of Pneumocystis Jirovecii Infection (see Pneumocystis Jirovecii, [[Pneumocystis Jirovecii]])
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Background/Physiology
Polysaccharides are the Main Structural Constituents of the Fungal Cell Wall
Glucan: most abundant polysaccharide component in the cell wall of most fungi
Glucan is Composed Mostly of Glucose Polymers: branching of chains is specific to the fungal species
Chitin
Mannan
(1–3)-β-D-Glucan
Rationale for (1–3)-β-D-Glucan Testing: (1–3)-β-D-Glucan is a fungal cell wall component that can be used as a non-invasive test to detect invasive fungal infections
Functional Aspects of (1–3)-β-D-Glucan Structure: within the fungal cell wall, (1–3)-β-D-Glucan exists as an insoluble structure
In the presence of blood or other body fluids, (1–3)-β-D-Glucan transforms into triple helix (most commonly) or single helix/random coil forms (less commonly) -> rendered soluble
Soluble (1–3)-β-D-Glucan functions to inhibit leukocyte phagocytosis
Clinical Aspects of (1–3)-β-D-Glucan Assays
Commercial (1–3)-β-D-Glucan Assays
Fungitell (Associates of Cape Cod, East Falmouth, MA): only FDA-approved kit
Fungitec-G (Seikagaku Biobusiness, Tokyo, Japan)
BGSTAR β-Glucan Test (Maruha, Tokyo, Japan)
Endosafe-PTS (Charles River Laboratories, Charleston, SC): intended only for research use
Beta-Glucan Test (Waco Pure Chemical Industries, Osaka, Japan): intended only for research use
Specimens
Serum: standardly used
Bronchoalveolar Lavage (BAL): unclear utility
Cerebrospinal Fluid: unclear utility
Recommendations for the Use of the (1–3)-β-D-Glucan Assay
Testing Should be Used in Conjunction with Other Methods for the Diagnosis of Invasive Fungal Infections
Testing Should Precede Anti-Fungal Therapy
Twice-Weekly Testing Should be Used for Surveillance of Infections in At-Risk Patients
Once-Weekly Testing Should be Used to Assess the Response to Treatment
Positive Test Results Should Be Confirmed with a Second New Specimen or Repeated from the Initial Specimen Prior to Acceptance as a True Positive
Further Study is Required to Determine the Usefulness of testing on Non-Serum Specimens
References
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Plasma (1–3)-beta-D-glucan and fungal antigenemia in patients with candidemia, aspergillosis, and cryptococcosis. J Clin Microbiol. 1995;33:3115–3118
(Clinical significance of [1–>3]-beta-D-glucan in pleural effusion and liquor). (Japanese) Kansenshogaku Zasshi. 1997;71:1210–1215
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Candida lusitaniae arthritis in an intravenous drug user. Mycoses. 2007;50:430–432
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Cerebrospinal fluid and plasma (1–>3)-beta-D-glucan as surrogate markers for detection and monitoring of therapeutic response in experimental hematogenous Candida meningoencephalitis. Antimicrob Agents Chemother. 2008;52:4121–4129
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Contribution of the (1–>3)-beta-D-glucan assay for diagnosis of invasive fungal infections. J Clin Microbiol. 2008;46:1009–1013
Role of (1–>3)-beta-D-glucan in the diagnosis of invasive aspergillosis. Med Mycol. 2009;47(suppl 1):S233-S240
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Epidemiology and outcome of invasive fungal infection in adult hematopoietic stem cell transplant recipients: Analysis of Multicenter Prospective Antifungal Therapy (PATH) Alliance registry. Clin Infect Dis. 2009;48:265–273
Biomedical Applications of Limulus Amebocyte Lysate. Biology and Conservation of Horseshoe Crabs 2009; Part 2: 315–329
Difficulties in using 1,3-(beta)-D-glucan as the screening test for the early diagnosis of invasive fungal infections in patients with haematological malignancies: High frequency of false-positive results and their analysis. J Med Microbiol. 2010;59(Pt 9):1016–1022
Fungal infections in transplant and oncology patients. Infect Dis Clin North Am. 2010;24:439–459
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Practice Guidelines for the Diagnosis and Management of Aspergillosis: 2016 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2016 Aug 15;63(4):e1-e60. doi: 10.1093/cid/ciw326. Epub 2016 Jun 29 [MEDLINE]
