Davis Christian, Wheat L Joseph, Myint Thein, Boulware David R, Bahr Nathan C
University of Kansas School of Medicine, Kansas City, Kansas, USA.
MiraVista Diagnostics, Indianapolis, Indiana, USA.
J Clin Microbiol. 2020 Mar 25;58(4). doi: 10.1128/JCM.02094-19.
Several case reports and cohort studies have examined the use of (1,3)-beta-d-glucan measurement with cerebrospinal fluid to diagnose fungal meningitis. This systematic review aims to characterize the evidence regarding cerebrospinal fluid (1,3)-beta-d-glucan measurement to detect fungal meningitis. We searched PubMed for (1,3)-beta-d-glucan and each of several distinct fungi, cerebrospinal fluid, and meningitis. Summary data including diagnostic performance (where applicable) were recorded. A total of 939 records were examined via a PubMed search. One hundred eighteen records remained after duplicates were removed, and 104 records were excluded, as they did not examine cerebrospinal fluid, included animals, or focused on nonfungal infections. Fourteen studies were included in this systematic review. A variety of fungi, including species of , , , , , and , were studied, although most were case reports. Diagnostic accuracy was examined in 5 studies. Cerebrospinal fluid (CSF) (1,3)-beta-d-glucan measurement showed >95% sensitivity in the corticosteroid injection-related outbreak of One study in meningitis found 53% (53/87) sensitivity and 87% (133/153) specificity, while another study of meningitis found 89% (69/78) sensitivity and 85% (33/39) specificity. CSF (1,3)-beta-d-glucan testing may be useful, primarily as a nonspecific marker of fungal meningitis. Although the FDA black box warning states that spp. do not make (1,3)-beta-d-glucan, the current evidence shows that (1,3)-beta-d-glucan is detectable in cryptococcal meningitis. Organism-specific testing should be used in conjunction with (1,3)-beta-d-glucan measurement.
多项病例报告和队列研究探讨了利用脑脊液检测（1,3）-β-D-葡聚糖来诊断真菌性脑膜炎。本系统评价旨在阐述有关脑脊液（1,3）-β-D-葡聚糖检测以发现真菌性脑膜炎的证据。我们在PubMed数据库中检索了（1,3）-β-D-葡聚糖以及几种不同的真菌、脑脊液和脑膜炎相关内容。记录了包括诊断性能（如适用）在内的汇总数据。通过PubMed检索共检查了939条记录。去除重复记录后剩余118条记录，其中104条记录被排除，因为它们未检测脑脊液、涉及动物或关注非真菌感染。本系统评价纳入了14项研究。研究了多种真菌，包括[此处原文可能遗漏具体真菌名称]等属的真菌，不过大多数是病例报告。5项研究考察了诊断准确性。在与皮质类固醇注射相关的[此处原文可能遗漏具体真菌名称]暴发中，脑脊液（CSF）（1,3）-β-D-葡聚糖检测显示敏感性>95%。一项关于[此处原文可能遗漏具体真菌名称]脑膜炎的研究发现敏感性为53%（53/87），特异性为87%（133/153），而另一项关于[此处原文可能遗漏具体真菌名称]脑膜炎的研究发现敏感性为89%（69/78），特异性为85%（33/39）。脑脊液（1,3）-β-D-葡聚糖检测可能有用，主要作为真菌性脑膜炎的非特异性标志物。尽管美国食品药品监督管理局（FDA）的黑框警告指出[此处原文可能遗漏具体真菌名称]不产生（1,3）-β-D-葡聚糖，但目前证据表明在隐球菌性脑膜炎中可检测到（1,3）-β-D-葡聚糖。应将针对特定病原体的检测与（1,3）-β-D-葡聚糖检测结合使用。
