Comparative evaluation of pan‐fungal real‐time PCR, galactomannan and (1‐3)‐β‐D‐glucan assay for invasive fungal infection in paediatric cancer patients

Abstract

Limited specific data and investigations are available for the diagnosis of Invasive Fungal Infection (IFI) in paediatrics cancer patients. Three non-invasive tests; Platelia Aspergillus EIA for galactomannan (GM), β-D-glucan (BDG) assay and pan-fungal real-time PCR for fungal DNA in blood were evaluated. One hundred twenty-five paediatrics cancer patients at the high risk of IFI were enrolled. Single blood and serum samples were evaluated by all the three methods. Patients were classified into 10 proven, 52 probable and 63 no IFI cases in accordance with EORTC MSG 2008 revised guidelines. The sensitivity, specificity, PPV and NPV of all the three tests in proven, probable and no IFIs cases were analysed singly and in combination. The sensitivity, specificity, PPV and NPV of GM, BDG and pan-fungal real-time PCR were: 87%, 61%, 81%, 69.5% for GM, 88%, 59.5%, 81%, 71.4% for BDG and 89%, 69.2%, 85%, 67.5% for PCR (95% CI). Among different combinations, best combination was found to be GM and PCR with sensitivity, specificity, PPV and NPV of 98.2%, 89.3%, 97.1% and 90% respectively. Single samples must be evaluated by combination of tests.

Utility of Fungal Cell Markers in Pediatric Bone Marrow Transplant Recipients for Screening and Diagnosis of Invasive Fungal Infections

“…It is important to note that the majority of cases of proven or probable IFD in this cohort were secondary to yeast infections, and only one patient had Fusarium infection. Comparable results were reported by Gupta et al [30] who included patients with hematologic malignancies and solid tumors. The following values were reported: sensitivity 80.2%, specificity 47.2%, PPV 68.9 and NPV 71.4%.…”

Diagnosis of invasive fungal diseases in haematology and oncology: 2018 update of the recommendations of the infectious diseases working party of the German society for hematology and medical oncology (AGIHO)

“…The combination testing of Aspergillus GM together with (1→3)β‐D‐glucan measurement were found clinically meaningful . Furthermore, growing evidence exists that the combination of Aspergillus GM and PCR has a better sensitivity than either test alone for diagnosis of invasive aspergillosis . Not only in serum, but in BAL as well the NPV to exclude IPA is high when combined use of Aspergillus GM and PCR .…”

“…123 Furthermore, growing evidence exists that the combination of Aspergillus GM and PCR has a better sensitivity than either test alone for diagnosis of invasive aspergillosis. 94,[124][125][126] Not only in serum, but in BAL as well the NPV to exclude IPA is high when combined use of Aspergillus GM and PCR. 82 It needs to be es- German study.…”

Translational Development and Application of (1→3)-β-d-Glucan for Diagnosis and Therapeutic Monitoring of Invasive Mycoses

“…and Pneumocystis jirovecii as well as molds such as Aspergillus spp. Despite the substantial heterogeneity among different studies, the BDG assay has good accuracy for distinguishing patients with proven or probable IFIs from patients without invasive fungal infection and in some cases can be used to monitor response to treatment [12,13,14,15,16]. In this section, we review seminal studies and recent advances in serum BDG testing to monitor response to antifungal therapy.…”