Use of Beta-D-Glucan for Monitoring Antifungal Therapy of a Multidrug Resistant Invasive Magnusiomyces capitatus Infection

Invasive fungal infection (IFI) with Magnusiomyces capitatus is rare, occurring mainly in patients with hematological diseases. We report first case of tissue invasive M. capitatus infection in a liver transplant recipient (LTR) and use of an IFI biomarker beta-D glucan (BDG) for monitoring antifungal therapy. A 59 year old male received 3rd liver transplant (LT) for primary sclerosing cholangitis and developed invasive tissue disease due to M. capitatus. BDG was done weekly to monitor the antifungal therapy. However in the 5th week there was sudden rise in BDG >523pg/ml despite dual antifungal. This was used as a guide to investigate for further persistence of focus for IFI and source control. M. capitatus was intermediate resistant to voriconazole and echinocandins. Voriconazole was stopped and LAmB was continued for 6 month. In our experience, biomarker BDG is proved helpful for diagnosis, monitoring the therapeutic efficacy and used as guide to decide the duration of antifungal therapy. J Microbiol Infect Dis 2020; 10(2):98-102.