Detection of beta-D-glucan for the diagnosis of invasive fungal infection in children with hematological malignancy

作者：Guitard Juliette^*; Tabone Marie Dominique; Senghor Yaye; Cros Cyrille; Moissenet Didier; Markowicz Karine; Valin Nadia; Leverger Guy; Hennequin Christophe

来源：Journal of Infection, 2016, 73(6): 607-615.

DOI：10.1016/j.jinf.2016.07.007

• Invasive fungal infection
• Diagnosis
• Follow up
• (1,3)-Beta-D-glucan
• Pediatrics
• Hematological malignancy

Objectives: The beta-D-glucan assay (BDG) has been added to the EORTC/MSG criteria for the diagnosis of invasive fungal infections (IFI), but data from pediatric populations is scarce. The aim of this study was to evaluate performance of BDG in a cohort of hemato-oncological children with hematological malignancy at risk for IFI.
Methods: 113 patients were included through an 18-month period. In addition to routine IFI screening, BDG was assayed once a week. IFIs were classified using EORTC/MSG criteria without including the BDG results. Performances were assessed after a ROC analysis for optimization and multivariate analysis to detect the causes of false positivity.
Results: 8 proven and 4 probable IFIs, and 7 possible IFIs were diagnosed in 9 and 7 patients, respectively. Sensitivity and specificity increased from 75% and 56% to 100% and 91.1%, respectively when considering the whole population and patients not having received any antifungals prior to the test. Multivariate analysis revealed that being younger than 7, severe colitis/mucositis, recent administration of polyvalent immunoglobulins and digestive colonization with Enterococcus sp were independent risk factors for false positivity.
Conclusions: BDG is a valuable test to detect IFI in pediatric patients not previously treated with antifungals and to detect the occurrence of chronic infection.

• 出版日期2016-12