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.
Highlights
Invasive fungal infections (IFDs) continue to be an important infectious complication in patients with haematological malignancy (HM) and those undergoing stem cell transplantation (HSCT)
The epidemiology of invasive fungal disease (IFD) is characterized by the predominance of invasive aspergillosis (IA) and a limited number of cases of invasive candidiasis (IC) as compared to other populations that are at risk for IC, such as intensive care unit (ICU)
In haematology patients, serum BDG can be used in screening, keeping in mind that a negative result does not exclude the presence of IFD, and repeated testing might be required, while two consecutive positive results are associated with very high probability of true positivity and should warrant complete diagnostic workup and therapeutic decisions
Summary
Invasive fungal infections (IFDs) continue to be an important infectious complication in patients with haematological malignancy (HM) and those undergoing stem cell transplantation (HSCT). Its performance is not perfect, it is the most important fungal marker in patients with HM, since aspergillosis is the most frequent IFD, while Candida infections are rather rare due to the common use of azole prophylaxis Another fungal marker is (1-3)-beta-D-glucan (BDG), which can be detected in serum for the diagnosis of aspergillosis and other IFDs. The usefulness of BDG in the haematology setting has been extensively studied, with certain differences emerging for this population. BDG can be a valuable contribution to the diagnosis and management of IFDs in the haematology setting, provided clinicians have thorough knowledge of the advantages and limitations of the use of the BDG test in this specific population, which are different from other patient populations such as critically ill or surgical patients.
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