ß-D-Glucan Assay in the Cerebrospinal Fluid for the Diagnosis of Non-cryptococcal Fungal Infection of the Central Nervous System: A Retrospective Multicentric Analysis and a Comprehensive Review of the Literature.

Abstract

BACKGROUND:

Except for cryptococcosis, fungal infection of the central nervous system (FI-CNS) is a rare but severe complication. Clinical and radiological signs are non-specific, and the value of conventional mycological diagnosis is very low. This study aimed to assess the value of β1,3-D-glucan (BDG) detection in the cerebrospinal fluid (CSF) of non-neonatal non-cryptococcosis patients.

METHODS:

Cases associated with BDG assay in the CSF performed in 3 French University Hospitals over 5 years were included. Clinical, radiological, and mycological results were used to classify the episodes as proven/highly probable, probable, excluded, and unclassified FI-CNS. Sensitivity and specificity were compared to that calculated from an exhaustive review of the literature.

RESULTS:

In total, 228 episodes consisting of 4, 7, 177, and 40 proven/highly probable, probable, excluded, and unclassified FI-CNS, respectively, were analysed. The sensitivity of BDG assay in CSF to diagnose proven/highly probable/probable FI-CNS ranged from 72.7% [95% confidence interval {CI}: 43.4%‒90.2%] to 100% [95% CI: 51%‒100%] in our study and was 82% in the literature. For the first time, specificity could be calculated over a large panel of pertinent controls and was found at 81.8% [95% CI: 75.3%‒86.8%]. Bacterial neurologic infections were associated with several false positive results.

CONCLUSIONS:

Despite its sub-optimal performance, BDG assay in the CSF should be added to the diagnostic armamentarium for FI-CNS.

• Authors: Jeanne Bigot, Jordan Leroy, Taieb Chouaki, Laurence Cholley, Naïke Bigé, Marie-Dominique Tabone, Eolia Brissot, Sophie Thorez, Julien Maizel, Hervé Dupont, Boualem Sendid, Christophe Hennequin, Juliette Guitard
• Journal: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America (Clin Infect Dis) Vol. 77 Issue 5 Pg. 711-720 (09 11 2023) ISSN: 1537-6591 [Electronic] United States
• PMID: 37132362 (Publication Type: Review, Journal Article)
• Copyright: © The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved. For permissions, please e-mail: [email protected].

Chemical References

• Glucans
• beta-Glucans

Topics

• Humans
• Glucans
• Retrospective Studies
• beta-Glucans
• Sensitivity and Specificity
• Cryptococcosis (diagnosis)
• Central Nervous System
• Multicenter Studies as Topic