Usefulness of ß-D-glucan for diagnosis and follow-up of invasive candidiasis in onco-haematological patients

Guitard, Juliette; Isnard, F; Tabone, Marie‐Dominique; Antignac, Marie; Brissot, Éolia; Senghor, Yaye; Petit, Arnaud; Leverger, Guy; Hennequin, Christophe

doi:10.1016/j.jinf.2018.01.011

Cited by 17 publications

(10 citation statements)

References 24 publications

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“…31,32 For the same reasons, we cannot comment on the follow-up evaluation of the antifungal efficacy. 33 The frequent overflow FA values are less convenient for the follow-up evaluation, unless a new test is performed after dilution, whereas the WA directly provides a wide range of values easy to follow. We could not assess whether performing a second test on sequential samples would result in a better performance of the assays either.…”

Section: Discussionmentioning

confidence: 99%

Prospective comparison of (1,3)-beta-D-glucan detection using colorimetric and turbidimetric assays for diagnosing invasive fungal disease

et al. 2021

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Serum (1→3)-β-D-glucan (BDG), an pan fungal antigen, is detected in some invasive fungal diseases (IFDs). We compared two commercial kits, the Fungitell assay (FA) (colorimetric) and the Wako assay (WA) (turbidimetric) over a 4-month period to prospectively test 171 patients who mainly had hematological conditions (62%) and experienced episodes (n = 175) of suspected invasive fungal infection. Twenty-three episodes due to BDG-producing fungi were diagnosed (pneumocystosis, n = 12; invasive aspergillosis, n = 5; candidemia, n = 3; invasive fusariosis, n = 2; hepato-splenic candidiasis, n = 1). Both assays provided similar areas under the curves (AUC = 0.9). Using the optimized positivity thresholds (≥120 pg/ml for FA and ≥ 4 pg/ml for WA), the sensitivity and specificity were 81.8% (CI95: 61.5–92.7), 94.8% (90.1–97.3) for FA and 81.8% (61.5–92.7), 95.4% (90.9–97.8) for WA. Negative predictive value was 97.3% (93.3–99.0) for both tests. If the manufacturer's positivity threshold (≥11 pg/ml) was applied, the WA sensitivity decreased to 50%. Among 71 patients with bacterial infections, 21.1% were FA-positive and 5.6% were WA-positive (p < 10−2). The WA performed similarly as compared to the FA with an optimized cutoff value. The WA is a single sample test that is clinically relevant when a prompt therapeutic decision is required. Lay Summary Serum (1→3)-β-D-glucan testing is dominated by two kits including Fungitell colorimetric assay (FA) and the Wako turbidimetric assay (WA). We compared them prospectively and observed that they both perform similarly when selecting their optimal threshold (≥120 pg/ml for FA and ≥ 4 pg/ml for WA).

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Section: Discussionmentioning

confidence: 99%

Prospective comparison of (1,3)-beta-D-glucan detection using colorimetric and turbidimetric assays for diagnosing invasive fungal disease

et al. 2021

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“…There are no data in haematology patients specifically on the performance of BDG in candidiasis, possibly because this IFD is not very frequent in patients routinely undergoing screening with fungal markers due to Candida-active prophylaxis. Indeed, the incidence rates of candidemia and chronic disseminated candidiasis in 3027 patients with HM ranged between 0.74-0.77 and 0.30-0.44 according to the group of patients [34]. However, comparison of the performance of BDG in different IFDs has been reported in recent studies.…”

Section: Bdg In Diagnosis Of Invasive Candidiasis and Invasive Asperg...mentioning

confidence: 99%

Beta-D-Glucan in Patients with Haematological Malignancies

Mikulska

Balletto

Castagnola

et al. 2021

JoF

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(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.

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“…In a study among oncology and hematology patients, the sensitivity and specificity of BDG at the time of diagnosis of invasive candidiasis was 43.5% and 73% [ 26 ], while the corresponding numbers in the surgical intensive care unit were 87% and 73% [ 27 ]. Posteraro et al compared the performance of BDG with that of Candida score and colonization index in septic patients with >5 days length of stay in an intensive care unit (ICU) [ 28 ].…”

Section: Current Diagnostics and Limitationsmentioning

confidence: 99%

“…Despite the limitations of BDG as a diagnostic tool for invasive candidiasis, it has a unique characteristic when used for monitoring the response to therapy due to its quantitative profile [ 26 ]. A negative slope in BDG levels correlates with a successful treatment outcome with a PPV of 90%, while a positive slope correlates with treatment failure with a negative predictive value (NPV) of 90% [ 33 , 34 ].…”

Section: Current Diagnostics and Limitationsmentioning

confidence: 99%

T2 Magnetic Resonance Assay: Overview of Available Data and Clinical Implications

Zacharioudakis

Zervou

Mylonakis

2018

JoF

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Invasive candidiasis is a common healthcare-associated infection with a high mortality rate that can exceed 60% in cases of septic shock. Blood culture performance is far from ideal, due to the long time to positivity and suppression by antifungal agents. The T2 Magnetic Resonance (T2MR) assay is an FDA-approved qualitative molecular diagnostic method that can detect and speciate the 5 most common Candida spp.; namely, Candida albicans, Candida glabrata, Candida parapsilosis, Candida tropicalis, and Candida krusei, in approximately 5 h. In a multicenter clinical trial that included both a prospective and a contrived arm to represent the full range of clinically relevant concentrations of Candida spp., T2MR demonstrated a sensitivity and specificity of 91.1% and 98.1%, respectively. The utility of T2MR in candidemia depends on the prevalence of disease in each clinical setting. In intensive care units and other high-prevalence settings, the incorporation of T2MR in diagnostic algorithms is very appealing. T2MR is expected to allow timely initiation of antifungal therapy and help with anti-fungal stewardship. In low-prevalence settings, the positive predictive value of T2MR might not be enough to justify initiation of antifungal treatment in itself. The performance of T2MR has not been studied in cases of deep-seated candidiasis. Despite some promising evidence in published clinical trials, further studies are needed to determine the performance of T2MR in invasive candidiasis without candidemia. Overall, experience with T2MR in everyday clinical practice is evolving but, in the right setting, this technology is expected to provide “actionable information” for the management of patients evaluated for candidemia.

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Usefulness of ß-D-glucan for diagnosis and follow-up of invasive candidiasis in onco-haematological patients

Abstract: BDG exhibits a low sensitivity to detect IC in PHM, but its kinetics correlates the clinical outcome. Additional studies are warranted in patients with CDC to evaluate the interest of monitoring BDG levels to anticipate the discontinuation of antifungal maintenance therapy.

Cited by 17 publications

References 24 publications

Prospective comparison of (1,3)-beta-D-glucan detection using colorimetric and turbidimetric assays for diagnosing invasive fungal disease

Prospective comparison of (1,3)-beta-D-glucan detection using colorimetric and turbidimetric assays for diagnosing invasive fungal disease

Beta-D-Glucan in Patients with Haematological Malignancies

T2 Magnetic Resonance Assay: Overview of Available Data and Clinical Implications

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