Detection of β-D-glucan for the diagnosis of invasive fungal infection in children with hematological malignancy. Issue 6 (December 2016)

• Record Type: Journal Article
• Authors: Guitard, Juliette; Tabone, Marie-Dominique; Senghor, Yaye; Cros, Cyrille; Moissenet, Didier; Markowicz, Karine; Valin, Nadia; Leverger, Guy; Hennequin, Christophe
• Is Part Of: Journal of infection. Volume 73:Issue 6(2016)
• Page Start: 607
• Page End: 615
• Publication Date: 2016-12
• Subjects: Invasive fungal infection -- Diagnosis -- Follow up -- (1, 3)-Beta-D-glucan -- Pediatrics -- Hematological malignancy; Infection -- Periodicals; Bacterial Infections -- Periodicals; Communicable Diseases -- Periodicals; Electronic journals; 616.905
• DOI: 10.1016/j.jinf.2016.07.007
• Languages: English
• ISSNs: 0163-4453

Abstract

Summary: Objectives: The ß-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. Highlights: One of the first study showing the value of β-D-glucan to diagnose IFI in Pediatrics. Performances of test improved in patients not previously treated with antifungals. β-D-glucan seric levels correlate the clinical outcome of invasive fungal infection. Interpretation must always be cautious due to a high rate of false-positivity. Recent administration of immunoglobulins is the main cause of false-positivity.