Valuable Role of Beta-D-Glucan in The Diagnosis of Invasive Fungal Infections in Patients with Hematological Malignancies

Abstract

Background: Invasive fungal infections (IFIs) are a major cause of severe illness and death in immunocompromised patients, especially  those with blood cancers. Diagnosing these infections is challenging due to nonspecific symptoms and the limited sensitivity of  traditional culture-based methods. Recently, rapid non-culture-based diagnostics, such as the 1,3- beta-D-glucan (BDG) assay, have  become important adjuncts to standard diagnostic tools.

Objective: To determine the diagnostic performance of BDG as an adjunct  diagnostic strategy for IFIs in patients with hematological malignancies.

Subjects and Methods: Fifty-one patients were enrolled from the Hemato-oncology Department of Ain Shams University Hospital in Egypt from May 2022 to April 2023. The enrolled subjects were  classified into healthy controls (n= 13), pathological controls (n= 13), and IFIs cases group (n = 25), patients were subjected to BDG test,  complete blood count (CBC) with differential, highly sensitive-C reactive protein (hs-CRP), and (Microbiological cultures and/or  histopathological examination).

Results: At a cut-off of 187.21 pg/ml the maximum efficacy of the BDG test was achieved concerning the  cases versus total controls with a sensitivity of 84%, specificity of 84.6%, negative predictive value (NPV) of 84.6%, positive predictive value  (PPV) 84%, and efficacy of 84.3%.

Conclusions: Identifying the BDG antigen can be a useful diagnostic approach for IFIs when applied in  the appropriate clinical context, such as in patients with weakened immune systems, low white blood cell counts, or blood cancers, by a healthcare professional who is well-informed about the test's strengths and weaknesses and can customize its use for optimal clinical  decision-making in each patient's case.