Diagnostic Accuracy of Serum 1,3-β- d -Glucan for Pneumocystis jiroveci Pneumonia, Invasive Candidiasis, and Invasive Aspergillosis: Systematic Review and Meta-Analysis

Abstract

Serum 1,3-␤-D-glucan (BG) assay may be helpful as a marker for the diagnosis of Pneumocystis jiroveci pneumonia (PJP) and invasive fungal infection (IFI).We conducted a systematic review to assess the diagnostic accuracy of this assay. We searched MEDLINE, Web of Science, Cochrane Collaboration databases, Ichushi-Web, reference lists of retrieved studies, and review articles. Our search included studies of serum BG assay that used (i) positive cytological or direct microscopic examination of sputum or bronchoalveolar lavage fluid for PJP and (ii) European Organization for Research and Treatment of Cancer or similar criteria for IFI as a reference standard and provided data to calculate sensitivity and specificity. Only major fungal infections such as invasive candidiasis and invasive aspergillosis were included in the IFI group. Twelve studies for PJP and 31 studies for IFI were included from January 1966 to November 2010. The pooled sensitivity, specificity, diagnostic odds ratio (DOR), and area under the summary receiver operating characteristic curve (AUC-SROC) for PJP were 96% (95% confidence interval [95% CI], 92% to 98%), 84% (95% CI, 83% to 86%), 102.3 (95% CI, 59.2 to 176.6) and 0.96 (95% CI, 0.94 to 0.99), respectively. No heterogeneity was found. For IFI, the values were 80% (95% CI, 77% to 82%), 82% (95% CI, 81% to 83%), 25.7 (95% CI, 15.0 to 44.1), and 0.88 (95% CI, 0.82 to 0.93). Heterogeneity was significant. The diagnostic accuracy of the BG assay is high for PJP and moderate for IFI. Because the sensitivity for PJP is particularly high, the BG assay can be used as a screening tool for PJP. P neumocystis jiroveci pneumonia (PJP) continues to be a serious problem among immunocompromised patients despite the decreased number of cases among human immunodeficiency virus (HIV)-infected patients over the past decade with the widespread use of prophylaxis. The high mortality of patients requiring mechanical ventilation has remained unchanged, ranging from 50 to 60% (35). Although the gold standard for diagnosis is microscopic visualization of the organism, the methods are not sensitive, particularly in HIV-negative patients (31).The incidence of invasive fungal infection (IFI) has been increasing, especially among immunocompromised patients undergoing aggressive chemotherapy for cancer, bone marrow and organ transplantation, and advanced critical care. Despite advances in therapy, IFI is associated with considerable morbidity and a mortality rate of 30 to 70% for aspergillosis and 40 to 50% for candidiasis (15). Diagnosis of IFI is challenging because clinical and radiological signs and conventional microbiological and histological techniques are not sensitive enough (25). For these reasons, intensive research currently aims at the development of new diagnostic methods for PJP and IFI.One of these new diagnostic techniques is the assay for the serum 1,3-␤-D-glucan (BG) derived from major cell wall components of various medically important fungi. The Fungitell test (Associates of Cape Cod, Inc., East Falm...

Value of β-d-glucan and Candida albicans germ tube antibody for discriminating between Candida colonization and invasive candidiasis in patients with severe abdominal conditions

“…A few studies have investigated the predictive value of BDG on IC in non-neutropenic critically ill patients [21][22][23][24][25]. Elevated concentrations of BDG have been reported to be associated with other fungi, such as Pneumocystis jirovecii infections [26], Gram-positive and Gram-negative bloodstream infections, exposure to gauze or other materials that contain glucans, biofilms on vascular catheters, hemodialysis, and administration of a,b Superscripts indicate significant differences (P \ 0.05) among rates of BDG and positive CAGTA values among the three study groups Fig. 2 Prediction rule for the diagnosis of invasive candidiasis (IC) in nonneutropenic adult critically ill patients with severe abdominal conditions.…”

“…The reason for ICU admission was medical in 18.8 % of patients, surgical in 76.1 %, and trauma in 5.1 %. The median (IQR) length of ICU and hospital stay was 15 (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27) and 38 (24-57) days, respectively, which were significantly higher in patients with IC compared to the other two groups. ICU and hospital crude mortality rates were 26.7 and 32.4 %, respectively.…”

Diagnostic accuracy of a novel lateral-flow device in invasive aspergillosis: a meta-analysis

“…Development of tests not based on cultures, such as the galactomannan assay (GM assay), (1R3)-b-D-glucan assay (G assay) and PCR has received significant attention from researchers. Meta-analyses have shown a sensitivity of 0.78, 0.77 and 0.75 and a specificity of 0.81, 0.83 and 0.87 for the GM assay, G assay and PCR, respectively, using serum (Leeflang et al, 2008;Mengoli et al, 2009;Onishi et al, 2012). Despite their wide usage, these tests have limitations, such as time and equipment requirements as well as the occurrence of significant performance variation.…”

Serum (1->3)-Β-D-Glucan Assay for Diagnosis of Pneumocystis Pneumonia in Immunocompromised Patients

“…However other studies didn't show significant difference between them [5,6,15]. Further evaluation is needed to develop this controversy.…”