Abstract
Purpose of ReviewThis review summarizes the fungal diagnostic measures currently available for use in paediatric patients at high risk for developing invasive fungal disease (IFD) and those suspected of having an IFD. The clinical utility of each test is described based on reported performances of individual tests in specific paediatric populations.Recent FindingsAvailable studies in the paediatric population are scarce and are characterized by a huge heterogeneity in underlying diseases (e.g. different risk for IFD), different study objectives and management strategies (screening versus diagnostic) used.SummaryA final valuation of paediatric studies on fungal diagnostic tools is limited. While the galactomannan and fungal PCR assays are useful to exclude the presence of IFD, it is unclear if mannan, mannan antibodies and β-D-glucan are of benefit due to a lack of studies or validation of the cut-off, respectively. Well-designed multicentre paediatric studies are urgently needed to improve the outcome of IFD.
Highlights
A timely diagnosis of invasive fungal disease (IFD) in children is a real challenge due to difficulties encountered in obtaining enough sample volumes, the need for anaesthesia to perform certain diagnostic procedures, and sparse clinical data with respect to the usefulness of fungal biomarkers and molecular detection methods
Two paediatric studies assessing the value of serum BDG in the diagnosis of IFD showed that this test is not a reliable efficient diagnostic tool in the paediatric patients with hematologic disorders (n = 62) and haematopoietic stem cell transplantation (HSCT) recipients (n = 34) due to a high number of false-positive and false-negative results when 80 pg/ml was used as the cut-off (Table 1) [18, 41]
The paediatric studies performed to date with GM and fungal PCR are supportive of its use to rule out IFD due to their high negative predictive values as seen in adult patients
Summary
A timely diagnosis of invasive fungal disease (IFD) in children is a real challenge due to difficulties encountered in obtaining enough sample volumes, the need for anaesthesia to perform certain diagnostic procedures, and sparse clinical data with respect to the usefulness of fungal biomarkers and molecular detection methods. Initial studies clearly showed the usefulness of this test in the early detection of invasive aspergillosis (IA) with positive test results in neutropenic patients before clinical signs and symptoms, including CT-chest abnormalities, develop [13].
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