Abstract
Limited specific data and investigations are available for invasive aspergillosis (IA) in pediatric patients. We evaluated the diagnostic potential of three noninvasive tests including the Platelia Aspergillus EIA kit for using galactomannan antigen, (1,3)-β-D-glucan Detection Reagent Kit, and nested-PCR for Aspergillus DNA in sera. We evaluated the diagnostic potential of three noninvasive tests including EIA for galactomannan antigen (Platelia Aspergillus), nested PCR assay for Aspergillus DNA and test for(1→3)-β-D-glucan (Glucatell assay Kit). All pediatric patients treated at the hematology/oncology unit who were at increased risk of developing invasive aspergillosis were enrolled. Clinical samples were examined for Aspergillus infections by mycological methods. Serial blood samples were collected twice weekly and evaluated by noninvasive tests. We analyzed 230 consecutive blood samples from 62 pediatric patients. The incidence rate of invasive aspergillosis in the patients was found to be 27.4%, and the etiologic agents were Aspergillus flavus, Aspergillus fumigatus, and Aspergillus spp. The sensitivity, specificity, positive and negative predictive values, and likelihood ratios for positive and negative results of galactomannan in patients with proven and probable IA were 90%, 92%, 81.8%, 96%, 11.25, and 0.1; for beta-D-glucan they were 50%, 46%, 26%, 70.6%, 0.9, 0.9; and for nested-PCR they were 80%, 96.2%, 88.9%, 92.6%, 21, and 0.2, respectively. The conventional methods are not able to detect IA, due to the lack of valid and proper sampling. Galactomannan and nested-PCR tests in serum, with enough accuracy and reliability, can serve as noninvasive methods for the detection of IA in pediatric patients. However, the beta-D-glucan test cannot serve as an efficient diagnostic tool in those with hematologic disorders.
Highlights
IntroductionThose with hematologic malignancies, are at increased risk of developing invasive aspergillosis (IA), which is a major cause of morbidity and mortality in immunosuppressed patients
Limited specific data and investigations are available for invasive aspergillosis (IA) in pediatric patients
We evaluated the diagnostic potential of three noninvasive tests for IA, including the Platelia Aspergillus EIA for GM antigen, Glucatell assay for BDG and the polymerase chain reaction assay for Aspergillus DNA in the sera of the pediatric patients
Summary
Those with hematologic malignancies, are at increased risk of developing invasive aspergillosis (IA), which is a major cause of morbidity and mortality in immunosuppressed patients. We evaluated the diagnostic potential of three noninvasive tests for IA, including the Platelia Aspergillus EIA for GM antigen, Glucatell assay for BDG and the polymerase chain reaction (nested PCR) assay for Aspergillus DNA in the sera of the pediatric patients. The patients did not receive any antifungal prophylaxis They were examined for signs of fungal infections twice weekly and clinical samples (88 samples including sputum, abdominal tap, cerebrospinal fluid, pleural, broncho alveolar lavage or bronchial washing, and biopsy) from those with positive signs were tested for Aspergillus infections by mycological methods, culture on Sabouraud dextrose agar (Merck, Darmstadt, Germany), and direct microscopic examination. Blood samples (5 ml) were cultured by bedside inoculation to BACTEC medium (BectonDickinson, Sparks, MD, USA) Radiologic studies such as chest X ray, sonography, and computed tomography from each body site were performed in patients with clinical signs and symptoms of the disease. All patients' written informed consent was obtained prior to the study
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