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

Abstract : 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.
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Journal of Infection, WB Saunders, 2016, 73 (6), pp.607-615. 〈10.1016/j.jinf.2016.07.007〉
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Juliette Guitard, Marie-Dominique Tabone, Yaye Senghor, Cyrille Cros, Didier Moissenet, et al.. Detection of β-D-glucan for the diagnosis of invasive fungal infection in children with hematological malignancy. Journal of Infection, WB Saunders, 2016, 73 (6), pp.607-615. 〈10.1016/j.jinf.2016.07.007〉. 〈hal-01628371〉

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