Page 102 - ITPS-8-2

INNOSC Theranostics

and Pharmacological Sciences

CASE SERIES
Evaluation of galactomannan and

1,3-β-d-glucan assays as diagnostic tools for
intracranial fungal infection: A case series

Suneel Kumar , Zuhaa Rehman* , Anabia Akhlaq , Taha Bin Ajaz Khan ,
Naeemullah Bullo, and Munir Afzal
Department of Neurology, Jinnah Postgraduate Medical Centre, Karachi, Sindh, Pakistan

Abstract

Fungal infections of the central nervous system have dramatically surged over the past
decade, particularly in semitropical regions such as Karachi. Herein, we retrospectively
evaluated the diagnostic potential of galactomannan (GM) and 1,3-β-d-glucan (BDG)
assays for intracranial fungal infections (IFI) at a tertiary care facility in Karachi. A total
of 12 patients (3 immunocompromised and 9 immunocompetent) aged 18 – 60 years
underwent serum fungal biomarker testing, imaging studies, and cerebrospinal
fluid (CSF) analysis. Suboptimal GM and high BDG titers indicated invasive mycoses.
Computed tomography scan revealed fungal sinusitis, and magnetic resonance
*Corresponding author: imaging revealed brain parenchyma involvement. Fungal biomarkers helped rule
Zuhaa Rehman out a neoplastic etiology. Normal GM and high BDG titers negated the probability of
(hayazoya44@gmail.com)
aspergillosis. Further, culture tests helped identify the causative organisms and tailor
Citation: Kumar S, Rehman Z, the treatment. Our findings emphasize the diagnostic value of GM and BDG assays
Akhlaq A, Khan TBA, Bullo N,
Afzal M. Evaluation of in IFIs. Furthermore, we recommend the use of CSF specimens for fungal biomarker
galactomannan and 1,3-β-d-glucan assays in future diagnostic protocols.
assays as diagnostic tools for
intracranial fungal infection: A case
series. INNOSC Theranostics Keywords: Intracranial fungal infection; Galactomannan; Fungal sinusitis; d-glucan;
and Pharmacological Sciences.
2025;8(2):96-101. 1,3-β-d-glucan
doi: 10.36922/itps.4528
Received: August 15, 2024
Revised: November 10, 2024 1. Background
Accepted: December 11, 2024 The incidence of fungal infections in the central nervous system (CNS) has increased
Published online: December 3, over the past decade and is primarily attributed to the growing population of
2025 immunocompromised individuals. The fungal species predominantly responsible
Copyright: 2025 Author(s). for these infections include yeasts (e.g., Candida spp.), molds, and filamentous
This is an Open-Access article fungi (e.g., Aspergillus spp.). Candida albicans, which typically spreads through
1
distributed under the terms of the
Creative Commons Attribution the hematogenous route, is a common cause of CNS infections that often present as
License, permitting distribution, meningitis. In addition, it sometimes manifests as chronic meningitis. It can lead to
and reproduction in any medium, brain abscesses, spinal infections, ventriculitis, or mycotic aneurysms and vasculitis,
provided the original work is
2
properly cited. ultimately leading to cerebral infarctions. The underlying mechanism for Candida
meningitis is the invasion of fungi through the blood–brain barrier (BBB). 3
Publisher’s Note: AccScience
Publishing remains neutral with Aspergillus fumigatus and Aspergillus flavus are strongly associated with invasive
regard to jurisdictional claims in 4
published maps and institutional aspergillosis (IA) and fungal sinusitis, respectively. Aspergillus infections are primarily
affiliations. transmitted through spores, and the lungs, head, and neck – particularly the paranasal

Volume 8 Issue 2 (2025) 96 doi: 10.36922/itps.4528