Performance of the beta-glucan test for the diagnosis of invasive fusariosis and scedosporiosis: a meta-analysis
Frédéric Lamoth, Márcio Nucci, Ana Fernández‐Cruz, Élie Azoulay, Fanny Lanternier, Jens Bremerich, Hermann Einsele, Elizabeth J. Johnson, Thomas Lehrnbecher, Toine Mercier, Luciana Porto, Paul E. Verweij, Lewis White, Johan Maertens, Alexandre Alanio, the 9th European Conference on Infections in Leukemia (ECIL-9), Robina Aerts, Murat Akova, Alexandre Alanio, Diana Averbuch, Ola Blennow, Stéphane Bretagne, Alessandro Busca, Thierry Calandra, Simone Cesaro, Catherine Cordonnier, Rafael de la Cámara, Caroline Garcia-Vidal, Lidia Gil, Andreas H. Groll, Raoul Herbrecht, Hans H. Hirsch, Peter Hubacek, Giuseppe Indolfi, Csaba Kassa, Katrien Lagrou, Frederic Lamoth, Thomas Lehrnbecher, Per Ljungman, Johan Maertens, Vincent Mallet, Rodrigo Martino, Varun Mehra, Toine Mercier, Małgorzata Mikulska, Márcio Nucci, Livio Pagano, Katia Perruccio, José Luís Piñana, Luciana Porto, Christine Robin, Emmanuel Roilides, Monica A. Slavin, Jan Styczyński, Frank Tverdek, Paul E. Verweij, Nadja Hawwa Vissing, Lewis White, Aliénor Xhaard, Olga Zajac Spychala
Abstract
The (1→3)-β-D-glucan (BDG) is a component of the fungal cell wall that can be detected in serum and used as an adjunctive tool for the diagnosis of invasive mold infections (IMI) in patients with hematologic cancer or other immunosuppressive conditions. However, its use is limited by modest sensitivity/specificity, inability to differentiate between fungal pathogens, and lack of detection of mucormycosis. Data about BDG performance for other relevant IMI, such as invasive fusariosis (IF) and invasive scedosporiosis/lomentosporiosis (IS) are scarce. The objective of this study was to assess the sensitivity of BDG for the diagnosis of IF and IS through systematic literature review and meta-analysis. Immunosuppressed patients diagnosed with proven or probable IF and IS, with interpretable BDG data were eligible. A total of 73 IF and 27 IS cases were included. The sensitivity of BDG for IF and IS diagnosis was 76.7% and 81.5%, respectively. In comparison, the sensitivity of serum galactomannan for IF was 27%. Importantly, BDG positivity preceded the diagnosis by conventional methods (culture or histopathology) in 73% and 94% of IF and IS cases, respectively. Specificity was not assessed because of lacking data. In conclusion, BDG testing may be useful in patients with suspected IF or IS. Combining BDG and galactomannan testing may also help differentiating between the different types of IMI.