Galactomannan and 1,3-β-d-Glucan Testing for the Diagnosis of Invasive Aspergillosis

Frédéric Lamoth

doi:10.3390/jof2030022

Abstract

Invasive aspergillosis (IA) is a severe complication among hematopoietic stem cell transplant recipients or patients with hematological malignancies and neutropenia following anti-cancer therapy. Moreover, IA is increasingly observed in other populations, such as solid-organ transplant recipients, patients with solid tumors or auto-immune diseases, and among intensive care unit patients. Frequent delay in diagnosis is associated with high mortality rates. Cultures from clinical specimens remain sterile in many cases and the diagnosis of IA often only relies on non-specific radiological signs in the presence of host risk factors. Tests for detection of galactomannan- (GM) and 1,3-β-d-glucan (BDG) are useful adjunctive tools for the early diagnosis of IA and may have a role in monitoring response to therapy. However, the sensitivity and specificity of these fungal biomarkers are not optimal and variations between patient populations are observed. This review discusses the role and interpretation of GM and BDG testing for the diagnosis of IA in different clinical samples (serum, bronchoalveolar lavage fluid, cerebrospinal fluid) and different groups of patients (onco-hematological patients, solid-organ transplant recipients, other patients at risk of IA).

Highlights

Invasive aspergillosis (IA) represents a major threat in patients with depressed immune system.Patients with hematologic malignancies and chemotherapy-induced neutropenia or hematopoietic stem cell transplantation (HSCT) are at highest risk [1]
IA is increasingly observed in patients populations with diverse types of underlying diseases and level of immunosuppression, such as solid-organ transplant recipients, patients with solid tumors, auto-immune disorders, congenital immunodeficiency or chronic pulmonary diseases [2,3]
Experts recommend to consider a higher value for bronchoalveolar lavage (BAL) and cerebrospinal fluid (CSF); 5 For the Fungitell assay, the manufacturer defines values

Summary

Introduction

Invasive aspergillosis (IA) represents a major threat in patients with depressed immune system. IA is increasingly observed in patients populations with diverse types of underlying diseases and level of immunosuppression, such as solid-organ transplant recipients, patients with solid tumors, auto-immune disorders, congenital immunodeficiency or chronic pulmonary diseases [2,3]. Diagnosis of IA remains difficult because of the lack of sensitivity of conventional culture methods. The role and interpretation of these tests for the diagnosis of IA in various populations and clinical settings is still debated because of their limited sensitivity and specificity. The objective of this review is to provide an overview of the current evidence of the performance of these tests and to discuss their role and interpretation in diverse patients populations

The Tests

The Performance

The Clinical Utility

Which Patient Should Be Tested?

When and How the Test Should Be Performed?

Conclusions