Serum (1–3)-β-D-Glucan (Fungitell, etc)


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]])

  • xxx

Diagnosis of Pneumocystis Jirovecii Infection (see Pneumocystis Jirovecii, [[Pneumocystis Jirovecii]])

  • xxx


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


  • 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


  • 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


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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]