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Development of a Method of Measuring β-D-Glucan and Its Use in Preemptive Therapy for Invasive Fungal Infections
1Fourth Department of Internal Medicine, Teikyo University School of Medicine, Mizonokuchi Hospital, Kawasaki 213-8507, Japan.
Abstract:
Invasive fungal infections (IFIs) are serious infections that develop in conjunction with neutropenia after chemotherapy for acute leukemia or with hematopoietic stem cell transplantation. Conventionally, empirical antifungal therapy was recommended to treat IFIs for patient safety despite a lack of evidence of fungal infections. However, many studies have indicated that antifungals were not necessary for over half of patients, and several detriments of empirical therapy were noted, e.g., antifungals caused adverse reactions, an increase in drug-resistant fungi was a possibility, and medical costs soared. β-D-glucan (BDG) is a component of clinically important fungi such as Aspergillus and Candida. The G-test was developed in Japan as a way to measure BDG in serum using a coagulation factor from the blood of the horseshoe crab. Pre-emptive antifungal therapy based upon serodiagnosis with a BDG or galactomannan assay and CT imaging has been introduced. With pre-emptive antifungal therapy, the prognosis is equivalent to that with empirical therapy, and the dose of the antifungal has been successfully reduced. Measurement of BDG has been adopted widely as a method of diagnosing IFIs and is listed in the key guidelines for fungal infections and febrile neutropenia.
Insights
Empirical antifungal therapy for invasive fungal infections (IFIs) is often unnecessary and costly. Measuring beta-D-glucan (BDG) allows for pre-emptive therapy, improving patient outcomes and reducing antifungal exposure.
Area of Science:
- Mycology
- Clinical Diagnostics
- Infectious Diseases
Background:
- Invasive fungal infections (IFIs) pose significant risks to patients with neutropenia, often treated with empirical antifungal therapy.
- Empirical antifungal use can lead to adverse reactions, drug resistance, and increased healthcare costs, with antifungals unnecessary for many patients.
- Conventional treatment approaches lack targeted evidence, prompting a need for more precise diagnostic methods.
Purpose of the Study:
- To evaluate the utility of beta-D-glucan (BDG) measurement in diagnosing IFIs.
- To assess the effectiveness of pre-emptive antifungal therapy guided by BDG assays.
- To compare pre-emptive therapy with conventional empirical antifungal strategies.
Main Methods:
- Utilized the G-test, a Japanese assay measuring serum beta-D-glucan (BDG) using horseshoe crab blood.
- Incorporated BDG assays alongside galactomannan assays and CT imaging for serodiagnosis.
- Implemented pre-emptive antifungal therapy based on diagnostic results.
Main Results:
- Pre-emptive antifungal therapy demonstrated equivalent prognosis to empirical therapy.
- Antifungal dosage was successfully reduced with the pre-emptive approach.
- BDG measurement is widely adopted for IFI diagnosis and included in major guidelines.
Conclusions:
- Beta-D-glucan (BDG) assays are valuable tools for diagnosing invasive fungal infections (IFIs).
- Pre-emptive antifungal therapy guided by BDG offers comparable outcomes to empirical treatment with reduced antifungal exposure.
- BDG measurement is a key diagnostic method recommended in clinical guidelines for managing IFIs and febrile neutropenia.
