title: Prospective Evaluation of Serum β-Glucan Testing in Patients With Probable or Proven Fungal Diseases.
abstract: Background.  Early diagnosis and treatment are crucial in invasive fungal diseases (IFD). Serum (1-3)-β-d-glucan (BG) is believed to be an early IFD marker, but its diagnostic performance has been ambiguous, with insufficient data regarding sensitivity at the time of IFD diagnosis (TOD) and according to outcome. Whether its clinical utility is equivalent for all types of IFD remains unknown. Methods.  We included 143 patients with proven or probable IFD (49 invasive candidiasis, 45 invasive aspergillosis [IA], and 49 rare IFD) and analyzed serum BG (Fungitell) at TOD and during treatment. Results.  (1-3)-β-d-glucan was undetectable at TOD in 36% and 48% of patients with candidemia and IA, respectively; there was no correlation between negative BG results at TOD and patients' characteristics, localization of infection, or prior antifungal use. Nevertheless, patients with candidemia due to Candida albicans were more likely to test positive for BG at TOD (odds ratio = 25.4, P = .01) than patients infected with other Candida species. In 70% of the patients with a follow-up, BG negativation occurred in >1 month for candidemia and >3 months for IA. A slower BG decrease in patients with candidemia was associated with deep-seated localizations (P = .04). Thirty-nine percent of patients with rare IFD had undetectable BG at TOD; nonetheless, all patients with chronic subcutaneous IFD tested positive at TOD. Conclusions.  Undetectable serum BG does not rule out an early IFD, when the clinical suspicion is high. After IFD diagnostic, kinetics of serum BG are difficult to relate to clinical outcome.
authors.affiliation: Unitéde Parasitologie-Mycologie, Service de Microbiologie Clinique; Université Paris Descartes, Sorbonne Paris-Cité.
authors.forename: Cécile
authors.initials: C
authors.lastname: Angebault
authors.affiliation: Centre d'Infectiologie Necker Pasteur; Université Paris Descartes, Sorbonne Paris-Cité,; Unité de Mycologie Médicale, Centre National de Référence Mycoses Invasives et Antifongiques, Institut Pasteur, Paris.
authors.forename: Fanny
authors.initials: F
authors.lastname: Lanternier
authors.affiliation: Service de Parasitologie-Mycologie.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Dalle
authors.affiliation: Centre d'Infectiologie Necker Pasteur.
authors.forename: Cécile
authors.initials: C
authors.lastname: Schrimpf
authors.affiliation: Centre d'Infectiologie Necker Pasteur.
authors.forename: Anne-Laure
authors.initials: AL
authors.lastname: Roupie
authors.affiliation: Unité de Parasitologie-Mycologie, Service de Microbiologie Clinique.
authors.forename: Aurélie
authors.initials: A
authors.lastname: Dupuis
authors.affiliation: Unité de Parasitologie-Mycologie, Service de Microbiologie Clinique.
authors.forename: Aurélie
authors.initials: A
authors.lastname: Agathine
authors.affiliation: Service de Néphrologie et Transplantation Adulte; Université Paris Descartes, Sorbonne Paris-Cité,; Réseau Thématique de Recherche et de SoinsCentaure, Labex Transplantex, Paris.
authors.forename: Anne
authors.initials: A
authors.lastname: Scemla
authors.affiliation: Service d'Hématologie Adulte; Université Paris Descartes, Sorbonne Paris-Cité.
authors.forename: Etienne
authors.initials: E
authors.lastname: Paubelle
authors.affiliation: Service d'Hématologie Clinique , Centre Hospitalier Universitaire Dijon Bourgogne .
authors.forename: Denis
authors.initials: D
authors.lastname: Caillot
authors.affiliation: Unité d'Immunologie, Hématologie et Rhumatologie Pédiatriques.
authors.forename: Bénédicte
authors.initials: B
authors.lastname: Neven
authors.affiliation: Unité d'Immunologie, Hématologie et Rhumatologie Pédiatriques; Unité d'Hygiène, Service de Microbiologie Clinique, Hôpital Necker-Enfants malades, Assistance Publique des Hôpitaux de Paris.
authors.forename: Pierre
authors.initials: P
authors.lastname: Frange
authors.affiliation: Service d'Hématologie Adulte; Université Paris Descartes, Sorbonne Paris-Cité.
authors.forename: Felipe
authors.initials: F
authors.lastname: Suarez
authors.affiliation: Unité Biologie et Pathogénicité Fongiques, Département de Mycologie, Institut Pasteur, Paris; Institut National de la Recherche Agronomique, Unité Sous Contrat 2019, Paris, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: d'Enfert
authors.affiliation: Centre d'Infectiologie Necker Pasteur; Université Paris Descartes, Sorbonne Paris-Cité,; Unité de Mycologie Médicale, Centre National de Référence Mycoses Invasives et Antifongiques, Institut Pasteur, Paris.
authors.forename: Olivier
authors.initials: O
authors.lastname: Lortholary
authors.affiliation: Unitéde Parasitologie-Mycologie, Service de Microbiologie Clinique; Université Paris Descartes, Sorbonne Paris-Cité,; Unité Biologie et Pathogénicité Fongiques, Département de Mycologie, Institut Pasteur, Paris; Institut National de la Recherche Agronomique, Unité Sous Contrat 2019, Paris, France.
authors.forename: Marie-Elisabeth
authors.initials: ME
authors.lastname: Bougnoux
keywords: (1-3)-β-d-glucan; diagnostic tool; invasive fungal diseases; kinetics