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Meta-Analysis
. 2023 Jul 6;61(7):myad061.
doi: 10.1093/mmy/myad061.

Performance of the beta-glucan test for the diagnosis of invasive fusariosis and scedosporiosis: a meta-analysis

Frederic Lamoth  1   2 , Marcio Nucci  3   4 , Ana Fernandez-Cruz  5 , Elie Azoulay  6 , Fanny Lanternier  7   8 , Jens Bremerich  9 , Hermann Einsele  10 , Elizabeth Johnson  11 , Thomas Lehrnbecher  12 , Toine Mercier  13   14 , Luciana Porto  15 , Paul E Verweij  16 , Lewis White  17 , Johan Maertens  14 , Alexandre Alanio  7   18 ; 9th European Conference on Infections in Leukemia (ECIL-9)
Collaborators, Affiliations
Meta-Analysis

Performance of the beta-glucan test for the diagnosis of invasive fusariosis and scedosporiosis: a meta-analysis

Frederic Lamoth et al. Med Mycol. .

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.

Keywords: Fusarium; Lomentospora prolificans; Scedosporium apiospermum; acute leukemia; beta-D-glucan; invasive fungal infections; transplant recipients.

Plain language summary

IF and IS are severe fungal infections for which diagnosis is often delayed. This meta-analysis shows that beta-glucan testing in serum had a sensitivity of about 80% for IF/IS and could detect the disease earlier compared to conventional diagnostic tests.

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Conflict of interest statement

Frederic Lamoth has received research funding from Gilead, MSD, Pfizer and Novartis, has participated to advisory boards of Gilead, MSD and Pfizer, and has received honoraria for conferences from Gilead and Mundipharma. All contracts were made with and fees paid to his institution (CHUV).

Fanny Lanternier has participated to advisory board of F2G and has received honoraria for speaker bureau from Pfizer, Gilead and F2G.

Jens Bremerich has received funding from Boehringer-Ingelheim and has participated to advisory board of Guerbet, SA. All contracts were made with and fees paid to his institution.

Ana Fernandez-Cruz has received research funding from Gilead, all contracts were made with and fees paid to her institution.

Hermann Einsele discloses consulting or advisory role for BMS/Celgene, Janssen, Amgen, Takeda, Sanofi, GSK, Novartis, research funding from BMS/Celgene, Janssen, Amgen, GSK, Sanofi, honoraria from BMS/Celgene, Janssen, Amgen, Takeda, Sanofi, GSK, Novartis, and travel support from BMS/Celgene, Janssen, Amgen, Takeda, Novartis, Sanofi

Thomas Lehrnbecher served as a consultant to Gilead Sciences, Pfizer, Merck/MSD, Mundipharma, and Roche, and in the speaker's bureau of Gilead Sciences, Merck/MSD, EUSA Pharma, Pfizer, and Sanofi Pasteur.

Toine Mercier has received consultancy fees from Gilead Sciences, Pfizer, and AstraZeneca, an unrestricted research grant from Gilead Sciences, and travel support from AstraZeneca, Amgen, and Pfizer.

Johan Maertens reports grant support, personal fees and non-financial support from MDS, Pfizer Inc., and Gilead, personal fees and non-financial support from Basilea Pharmaceuticals, Mundipharma and F2G.

Alexandre Alanio has participated to advisory boards of Gilead and has received honoraria for conferences from Gilead and Pfizer and non-financial support from Gilead.

All other authors have no conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.
Algorithm for screening and selection of publications. BDG: (1→3)-β-D-glucan, EORTC-MSGERC: European Organisation for Research and Treatment of Cancer and Mycoses Study Group Education and Research Consortium, IFI: invasive fungal infection.
See this image and copyright information in PMC

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Supplementary concepts