Management of Elevated Fungitell Results

Understanding the Fungitell Test

The Fungitell test is an FDA-approved serum assay that detects (1,3)-β-D-glucan, a cell wall component found in many fungi, with a pooled sensitivity of 75-80% and specificity of approximately 80% for diagnosing invasive fungal infections, according to the Infectious Diseases Society of America 1, 2
The test has a high negative predictive value (>90%), making it useful for ruling out invasive fungal infections, as stated by the European Society of Clinical Microbiology and Infectious Diseases 2
False positive results are common, particularly in ICU patients, those on hemodialysis, and those receiving albumin or intravenous immunoglobulin infusions, as noted by the American College of Physicians 1

Evaluate patients for risk factors for invasive fungal infections, such as neutropenia, hematologic malignancy, transplantation, and prolonged ICU stay, as recommended by the Centers for Disease Control and Prevention 3, 1
Consider additional diagnostic testing, including blood cultures, site-specific cultures, and high-resolution chest CT, as suggested by the American Thoracic Society 1, 4
For suspected aspergillosis, perform galactomannan testing on serum and/or bronchoalveolar lavage fluid, as recommended by the European Respiratory Society 2, 3

Initiate antifungal therapy in patients with a positive Fungitell result plus positive cultures or histopathology from normally sterile sites, as recommended by the Infectious Diseases Society of America 1, 4
Consider antifungal therapy in patients with a positive Fungitell result plus clinical signs of infection and high-risk factors, such as neutropenia or transplant recipient, as suggested by the American Society of Transplantation 2, 1

Treat documented candidemia for at least 14 days after the first negative blood culture and resolution of symptoms, as recommended by the Infectious Diseases Society of America 1
Perform follow-up testing, including imaging, cultures, and β-D-glucan levels, to assess response to therapy, as suggested by the European Society of Clinical Microbiology and Infectious Diseases 2, 1

Source control, such as removal of infected catheters or drainage of abscesses, is crucial for successful treatment, as noted by the Society for Healthcare Epidemiology of America 1
The sensitivity of blood cultures for detecting invasive fungal infections is limited (21-71%), so negative cultures do not rule out infection, as stated by the Clinical Microbiology and Infection journal 6