Beta-D-Glucan in Patients with Haematological Malignancies

Abstract

(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.

Invasive fungal infections in patients with multiple myeloma: a possible growing problem in hematology and infectious diseases

“…Another serum marker, 1-3-beta- d -glucan (BDG), can be detected in most cases of IFIs (except Mucorales , Blastomyces , and most Cryptococci ), with lower sensitivity in invasive aspergillosis compared to candidiasis. 64 However, BDG is not specific for any fungal pathogen and thus must be used in combination with other diagnostics [radiology, polymerase chain reaction (PCR), culture-based tests, and non-culture-based tests] and clinical presentation. Among hematological patients, the specificity of BDG can be increased by obtaining two consecutive positive assays and by avoiding testing if there are factors that lead to false-positive results, for example, prior treatment with immunoglobulins, albumins, beta-lactam antibiotics, pegylated asparaginase, or hemodialysis; concomitant bacterial infections with Pseudomonas spp., Nocardia spp., or Streptococcus pneumoniae Type 37; chronic renal disease; end-stage liver disease or severe mucositis.…”

“…Among hematological patients, the specificity of BDG can be increased by obtaining two consecutive positive assays and by avoiding testing if there are factors that lead to false-positive results, for example, prior treatment with immunoglobulins, albumins, beta-lactam antibiotics, pegylated asparaginase, or hemodialysis; concomitant bacterial infections with Pseudomonas spp., Nocardia spp., or Streptococcus pneumoniae Type 37; chronic renal disease; end-stage liver disease or severe mucositis. 64 False-negative results can be caused by prior antifungal prophylaxis and treatment, hyperbilirubinemia, C. parapsilosis and C. auris infections, or infection of poorly vascularized sites. 64 Sterile fluids (e.g.…”

“… 64 False-negative results can be caused by prior antifungal prophylaxis and treatment, hyperbilirubinemia, C. parapsilosis and C. auris infections, or infection of poorly vascularized sites. 64 Sterile fluids (e.g. cerebrospinal fluid) are suitable for BDG testing if there is suspicion of central nervous system involvement but, unfortunately, bronchoalveolar lavage is not suitable material for BDG testing.…”

“…cerebrospinal fluid) are suitable for BDG testing if there is suspicion of central nervous system involvement but, unfortunately, bronchoalveolar lavage is not suitable material for BDG testing. 64 Finally, although PCR is a very promising method for diagnostic confirmation of IFI from various samples (especially bronchoalveolar lavage), it is not yet sufficiently standardized in terms of protocols for DNA extraction and PCR assays. 65 …”

Microbiological Non-Culture-Based Methods for Diagnosing Invasive Pulmonary Aspergillosis in ICU Patients

“…Due to different manufacturers, assays have different methods for BDG detection and cut-off values [ 20 ]. Comparisons between different assays have mostly been performed between Fungitell (Associated Cape-Cod, Inc., East Falmouth, MA, USA) and Wako (Wako Pure Chemical Industries, Tokyo, Japan) assays using serum but not BAL.…”