Beta-D-Glucan Level by Protease Zymogen Colorimetry

Bacterial/ Viral

Report in 48Hrs

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No Fasting Required

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Detects fungal cell wall component in blood.

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Beta-D-Glucan Level by Protease Zymogen Colorimetry - Comprehensive Medical Test Guide

Section 1: Why is it done?
- Test Purpose: Detects and quantifies beta-D-glucan, a cell wall component found in various fungal species including Candida, Aspergillus, Cryptococcus, and Pneumocystis. This test uses protease zymogen colorimetry methodology to measure circulating beta-D-glucan levels in blood serum.
- Primary Indications: Diagnosis of invasive fungal infections in immunocompromised patients; Early detection of candidiasis and aspergillosis; Monitoring disease progression in patients with suspected fungal infections; Risk stratification in critically ill or ICU patients; Evaluation of persistent fever of unknown origin when fungal infection is suspected
- Typical Clinical Scenarios: HIV/AIDS patients with CD4 counts below 200 cells/μL; Neutropenic patients undergoing chemotherapy; Organ transplant recipients; Patients on prolonged broad-spectrum antibiotics; Critically ill patients with risk factors for invasive candidiasis; Patients with indwelling central venous catheters; Post-operative patients with sepsis
Section 2: Normal Range
- Reference Range Values: Negative/Normal: Less than 60 pg/mL (picograms per milliliter) Borderline/Equivocal: 60-79 pg/mL Positive/Abnormal: 80 pg/mL or greater
- Units of Measurement: Picograms per milliliter (pg/mL); Results reported as quantitative values or qualitative interpretation
- Result Interpretation: Negative Result: <60 pg/mL indicates absence of detectable beta-D-glucan, suggesting no active invasive fungal infection (though does not exclude early infection or certain species like Cryptococcus neoformans and Blastomyces dermatitidis); Equivocal Result: 60-79 pg/mL warrants repeat testing within 24-48 hours or correlation with clinical presentation; intermediate probability of invasive fungal disease; Positive Result: ≥80 pg/mL strongly suggests presence of invasive fungal infection; higher values correlate with higher fungal burden and disease severity
- Normal vs Abnormal Significance: Normal levels typically indicate immunocompetence or absence of active invasive fungal infection; Abnormal elevation suggests active fungal infection requiring immediate clinical evaluation and potential antifungal therapy
Section 3: Interpretation
- Negative Results (<60 pg/mL): Suggests absence of invasive fungal infection at time of testing; Does not exclude early-stage infection (sensitivity increases over disease course); May not detect non-glucan-containing fungi (Cryptococcus, Blastomyces, Histoplasma); Helpful for ruling out invasive candidiasis and Aspergillus in appropriate clinical context; Negative predictive value approaches 95% in high-risk populations
- Borderline/Equivocal Results (60-79 pg/mL): Indicates intermediate probability of fungal infection; May reflect early infection or recovering immune status; Recommend repeat testing after 24-48 hours to confirm trend; Consider clinical context, risk factors, and symptoms when interpreting; Rising trend on repeat testing increases likelihood of true infection
- Positive Results (≥80 pg/mL): Strong evidence of invasive fungal infection; Indicates active disease requiring treatment; Positive predictive value approximately 85-95% in high-risk patients; Levels may correlate with fungal burden and treatment response; Higher values (>200 pg/mL) associated with more severe disease; Suggests initiation or continuation of antifungal therapy
- Factors Affecting Results: Timing of sample collection relative to infection onset (false negatives in early infection); Fungal species involved (beta-glucan present in Candida and Aspergillus, absent in Cryptococcus and endemic fungi); Degree of immunosuppression and immune recovery status; Antifungal therapy duration and response (levels decrease with successful treatment); Colonization vs. infection status (colonization may not elevate levels); Contamination risks with certain collection tubes; use appropriate specimen containers; Prior transfusions of blood products (can increase levels); Severe bacterial infections (potential for cross-reactivity)
- Clinical Significance Patterns: Rising trend (serial measurements): Indicates progressive infection, poor prognosis; requires intervention; Falling trend: Suggests effective antifungal therapy and immune recovery; Persistently elevated: May indicate treatment failure or inadequate dosing; Single positive result in high-risk patient: Warrants immediate clinical action and confirmation with other diagnostic modalities; Serial negatives: Supports absence of infection or successful clearance
Section 4: Associated Organs
- Primary Organ Systems Involved: Immune system (primary defense against fungal organisms); Gastrointestinal tract (primary source of Candida colonization and translocation); Lungs (common site of Aspergillus and other fungal infections); Central nervous system (fungal meningitis complications); Bloodstream/cardiovascular (disseminated infection and fungemia); Liver and spleen (fungal hepatosplenic disease); Kidneys (antifungal drug metabolism and potential toxicity)
- Common Associated Diseases and Conditions: Invasive Candidiasis (candidemia): Most common nosocomial fungal infection; associated with ICU admission, central lines, broad-spectrum antibiotics; Invasive Aspergillosis: Particularly Aspergillus fumigatus; occurs in severely immunocompromised patients including those with prolonged neutropenia; Pneumocystis Pneumonia (PCP): Occurs in HIV/AIDS patients with CD4 <200 cells/μL; Cryptococcal Infection: Primarily meningitis in advanced HIV disease; less reliably detected by beta-glucan (species variation); Fungal Sepsis: Severe systemic infection with hemodynamic instability; Disseminated Fungal Infection: Multi-organ involvement with high mortality risk; HIV/AIDS with opportunistic fungal infections: Significantly elevated beta-glucan in active infection; Hematologic Malignancies: Particularly acute leukemias with prolonged neutropenia; Solid Organ Transplantation: Especially lung and liver transplants; Severe Trauma or Burns: Disruption of mucosal barriers increasing translocation risk
- Potential Complications of Abnormal Results: Septic shock and multi-organ failure from disseminated infection; Acute respiratory distress syndrome (ARDS) from pulmonary involvement; Fungal meningitis with neurologic sequelae; Endocarditis with valve damage; Hepatic dysfunction from fungal hepatitis; Renal failure requiring dialysis; Medication toxicity from antifungal therapy (amphotericin B nephrotoxicity, azole hepatotoxicity); Immune reconstitution inflammatory syndrome (IRIS) in HIV patients; Death if untreated or inadequately treated (mortality rates 30-70% depending on fungal species and host factors)
- Risk Factors for Abnormal Results: Severe immunosuppression (CD4 <200, absolute neutrophil count <500); Prolonged ICU stay; Central venous catheterization; Total parenteral nutrition (TPN); Broad-spectrum antibiotic therapy; Recent abdominal surgery; Solid organ or bone marrow transplantation; Active chemotherapy or immunosuppressive medications; Uncontrolled diabetes mellitus; Severe malnutrition
Section 5: Follow-up Tests
- Confirmatory and Diagnostic Tests: Blood Cultures: Gold standard for identifying specific fungal organisms; multiple sets recommended; may take 5-10 days to grow; Galactomannan Antigen Test: Specific for Aspergillus species; complements beta-glucan testing; Mannan and Anti-Mannan Antibodies: Candida-specific antigens useful for candidiasis confirmation; Fungal PCR Testing: Molecular methods for rapid identification of specific fungal species (Candida, Aspergillus, Cryptococcus, Pneumocystis); (1→3)-Beta-D-Glucan Testing: Alternative methodology for beta-glucan measurement; helps confirm results
- Imaging and Diagnostic Procedures: High-Resolution CT Chest: For suspected pulmonary Aspergillus infection (halo sign, cavitation); Abdominal CT/Ultrasound: For hepatosplenic candidiasis assessment; Lumbar Puncture with CSF Analysis: For fungal meningitis evaluation if neurologic symptoms present; Echocardiography: Assess for fungal endocarditis in positive cases; Tissue Biopsy with Histopathology and Culture: Definitive diagnosis of invasive fungal infection; PCR testing of specimens
- Recommended Monitoring Tests for Positive Results: Repeat Beta-D-Glucan Levels: Every 48-72 hours initially to assess trend during treatment; assess response to antifungal therapy; Complete Blood Count (CBC): Monitor for leukocyte recovery and immune reconstitution; Comprehensive Metabolic Panel (CMP): Monitor renal and hepatic function during antifungal therapy; Lactate Dehydrogenase (LDH): Monitor tissue damage and treatment response; Prothrombin Time (PT/INR): Assess liver function and bleeding risk if azole-based therapy used
- Suggested Monitoring Frequency: High-Risk ICU Patients: Beta-glucan twice weekly for screening; daily if positive result; Positive Result at Presentation: Repeat testing every 48-72 hours during first 2 weeks of treatment; Borderline Result: Repeat within 24-48 hours initially; then based on clinical response; Long-term Monitoring: Continue periodic testing throughout antifungal course; especially important for assessing treatment failure; Post-Treatment Surveillance: Negative repeat tests support adequate treatment response and clearance
- Complementary Tests Providing Additional Information: CD4 Count and HIV Viral Load: Assess immune status and HIV disease progression in HIV-positive patients; Antifungal Drug Level Monitoring: Therapeutic drug monitoring for azoles (fluconazole, voriconazole) to optimize dosing; Susceptibility Testing: When organism identified, antifungal susceptibility testing guides therapy selection; Fungal Serology: Antibody testing for endemic fungi (Histoplasma, Blastomyces, Coccidioides) if appropriate to clinical context
Section 6: Fasting Required?
- Fasting Requirement: NO - Fasting is not required for the Beta-D-Glucan Level test by Protease Zymogen Colorimetry
- Rationale: Beta-D-glucan levels are not affected by nutritional status or food intake; Test can be performed at any time of day; No specific preparation for food or fluid intake is necessary
- Specimen Collection Requirements: Specimen Type: Serum (preferably) or plasma (depending on lab protocol); Collection Tube: Typically non-pyrogenic, non-glucan-containing blood collection tubes; gold-top serum separator tubes preferred by most laboratories; Volume: Usually 3-5 mL of blood; Important: Avoid pyrogen-contaminated tubes or regular glass tubes (may contain contaminants affecting results); Specimen Handling: Allow blood to clot at room temperature for 30-45 minutes if serum required; separate serum by centrifugation; Storage: Refrigerate at 2-8°C if testing delayed; some labs may accept frozen specimens; consult specific laboratory for storage requirements
- Medications: No RestrictionsContinue all routine medications as prescribed; Antifungal medications do not need to be held prior to testing; Include any antifungal therapy in clinical history provided to laboratory for result interpretation
- General Patient Preparation: No special diet restrictions; No fluid intake restrictions; Normal daily activities permitted; Inform phlebotomist of any central lines or peripheral IV lines for optimal collection site selection; Inform laboratory if recent transfusion (may affect results); Provide clinical history and risk factors to laboratory for appropriate interpretation; Timing: Can be drawn at any time; for hospitalized ICU patients, may be drawn with routine morning labs
- Important Considerations: Contamination Prevention: Proper venipuncture technique essential to avoid false positives from environmental contamination; Tube Selection Critical: Use only laboratory-approved collection tubes free from glucan contamination; Clinical Context Essential: Results must be interpreted with clinical presentation, risk factors, and other diagnostic findings; Timing Matters: Serial testing more valuable than single result; trends indicate clinical significance; Laboratory Variation: Different laboratories may use different methodologies (protease colorimetric, kinetic chromogenic, or LAL-based); reference ranges may vary slightly; consult specific laboratory for their reference ranges and interpretation guidelines

How our test process works!