Contribution of the (1 3)--D-Glucan Assay for the Diagnosis of Invasive Fungal Infections

Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Parasitologie, Mycologie Médicale et Maladies Tropicales, Lyon, France, Laboratoire de Parasitologie-Mycologie, AP-HM Timone, Marseille; Laboratoire de Parasitologie-Mycologie, Hôpital Saint Louis, Paris, France

^* To whom correspondence should be addressed. Email: florence.persat{at}univ-lyon1.fr.

	Abstract

Diagnosis of invasive fungal infection (IFI) remains a challenge. A retrospective study was performed on 279 patients in three French university hospitals to evaluate the performance of the (1 3)--D-glucan assay (BG assay; Fungitell®, Associates of Cape Cod, Inc.) for the diagnosis of IFI. The results of one serum per subject were analysed for 117 patients who had probable or proven IFI according to the European Organisation for Research and Treatment of Cancer (EORTC) criteria (70 invasive pulmonary aspergilloses (IPA), 27 fungal bloodstream infections and 20 Pneumocystis jiroveci pneumonias), 40 blood donors and 122 patients who were hospitalized in haematology wards or intensive care units and were at risk for IFI but in whom IFI had not been diagnosed. For the overall IFI diagnosis, the BG assay had 77.8% sensitivity and specificities of 92.5 and 70.5% for blood-donors and patients at risk, respectively. The assay was positive in 48 patients with IPA (68%), in 23 with bloodstream infections (85.2%) and in all who had Pneumocystis jiroveci pneumonias (100%), and the false positive rate varied depending on the controls used. It allowed a higher rate of detection among IPA patients compared with the galactomannan enzyme-linked immunosorbent assay (ELISA) (48 versus 39 patients, respectively) and among candidaemia patients compared with the mannan ELISA (20 versus 11 patients, respectively). This assay thus appears useful in the diagnosis of IFI, particularly for serum analysis of pneumocystosis pneumonia patients, but further studies are needed to evaluate false-positive rates and its future role in IFI diagnosis.