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Detection of (1,3)-β-d-Glucan in Cerebrospinal Fluid in Histoplasma Meningitis

Thein Myint1, Felicia C Chow2, Karen C Bloch3

  • 1Division of Infectious Diseases, Department of Internal Medicine, University of Kentucky, Lexington, Kentucky, USA thein.myint3@uky.edu.

Journal of Clinical Microbiology
|July 20, 2018
PubMed

Insights

Diagnosing central nervous system (CNS) histoplasmosis is challenging. Cerebrospinal fluid (CSF) (1,3)-β-d-glucan (BDG) testing showed limited sensitivity and specificity for identifying Histoplasma meningitis.

Area of Science:

  • Mycology
  • Infectious Diseases
  • Neurology

Background:

  • Central nervous system (CNS) histoplasmosis diagnosis is challenging.
  • Cerebrospinal fluid (CSF) (1,3)-β-d-glucan (BDG) is a biomarker for fungal meningitis, but its utility in Histoplasma meningitis is understudied.
  • Limited data exist on the diagnostic performance of CSF BDG for Histoplasma meningitis.

Purpose of the Study:

  • To evaluate the diagnostic utility of CSF BDG detection using the Fungitell assay for CNS histoplasmosis.
  • To compare CSF BDG levels in patients with CNS histoplasmosis against various control groups.
  • To determine the sensitivity and specificity of CSF BDG for diagnosing Histoplasma meningitis.

Main Methods:

  • Retrospective case-control study design.
  • Inclusion of 47 patients with CNS histoplasmosis and 153 controls.
  • Analysis of CSF BDG levels using the Fungitell assay.

Main Results:

  • Median CSF BDG level was 85 pg/ml in CNS histoplasmosis cases versus <31 pg/ml in all controls (P < 0.05).
  • CSF BDG sensitivity was 53.2% and specificity was 86.9% against all controls.
  • Specificity dropped to 46% when compared against controls with other CNS fungal infections.

Conclusions:

  • CSF BDG levels ≥80 pg/ml are neither sensitive nor specific enough to definitively diagnose Histoplasma meningitis.
  • The diagnostic performance of CSF BDG for Histoplasma meningitis is limited, especially when differentiating from other fungal CNS infections.
  • Further research is needed to improve diagnostic strategies for CNS histoplasmosis.
Keywords:
(1,3)-β-d-glucanHistoplasmacerebrospinal fluidmeningitis

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