Diagnosis of invasive fungal disease in children: a narrative review

Saffioti, Carolina; Mesini, Alessio; Bandettini, Roberto; Castagnola, Elio

doi:10.1080/14787210.2019.1690455

Cited by 6 publications

(4 citation statements)

References 160 publications

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“…Recent review papers [68][69][70] showed a poor performance of the test in paediatrics, unless using a cut-off much higher than the 80 pg/mL, indicated as a threshold for a positive test [68]; it is discouraged for prospective monitoring or diagnostic use in paediatric patients at high risk of invasive fungal disease in the most recent guideline on management of IFD in children receiving chemotherapy or SCT (grade D recommendation, level of evidence II) [71]. Recently, BDG has been proposed in combination with GM and Aspergillus PCR for the diagnosis of invasive aspergillosis in paediatric patients [72].…”

Section: Bdg In Children With Haematological Malignancies Undergoing ...mentioning

confidence: 99%

“…In haematological patients, high specificity of two consecutive positive tests [31][32][33] The need to use glucan-free laboratory materials [15] More sensitive than blood cultures for deep-seated candidiasis [1] Possibility of false positive results (see Table 2) [2,[15][16][17][18][19][20][21][22][23][24][25][26][27] High sensitivity for PJP [53][54][55] Lower sensitivity in patients with haematologic malignancies and IFD compared to other patient groups [16,18] The only non-invasive test to support the diagnosis of PJP, especially in situations where critical illness precludes invasive diagnostic procedures such as BAL [42] Of limited use in paediatric population [68][69][70] Possibility of use in other sterile fluids such as cerebrospinal fluid for fungal central nervous system infections [64,65] In case of invasive candidiasis, lower sensitivity in case of certain species, such as C.…”

Section: Strengths Limitationsmentioning

confidence: 99%

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Beta-D-Glucan in Patients with Haematological Malignancies

Mikulska

Balletto

Castagnola

et al. 2021

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(1-3)-beta-D-glucan (BDG) is an almost panfungal marker (absent in zygomycetes and most cryptococci), which can be successfully used in screening and diagnostic testing in patients with haematological malignancies if its advantages and limitations are known. The aim of this review is to report the data, particularly from the last 5 years, on the use of BDG in haematological population. Published data report mainly on the performance of the Fungitell™ assay, although several others are currently available, and they vary in method and cut-off of positivity. The sensitivity of BDG for invasive fungal disease (IFD) in haematology patients seems lower than in other populations, possibly because of the type of IFD (lower sensitivity was found in case of aspergillosis compared to candidiasis and pneumocystosis) or the use of prophylaxis. The specificity of the test can be improved by using two consecutive positive assays and avoiding testing in the case of the concomitant presence of factors associated with false positive results. BDG should be used in combination with clinical assessment and other diagnostic tests, both radiological and mycological, to provide maximum information. Good performance of BDG in cerebrospinal fluid (CSF) has been reported. BDG is a useful diagnostic method in haematology patients, particularly for pneumocystosis or initial diagnosis of invasive fungal infections.

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Section: Bdg In Children With Haematological Malignancies Undergoing ...mentioning

confidence: 99%

Section: Strengths Limitationsmentioning

confidence: 99%

Beta-D-Glucan in Patients with Haematological Malignancies

Mikulska

Balletto

Castagnola

et al. 2021

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“…19 Saat ini, beberapa pendekatan diagnostik kandidemia meliputi kultur darah dan histopatologi, biomarker atau antibodi (galactomannan, β-D-glucan, mannan dan anti-mannan), dan modalitas pencitraan radiologis (CTscan thorax, MRI otak dan liver, USG, dan lain lain). 20,21 Diagnosis kandidemia berdasarkan kultur memiliki sensitivitas antara 21-71% dan hal ini berkaitan dengan masalah jumlah sampel yang terambil. 22 Di sisi lain, PCR memiliki masalah dalam hal standarisasi metode yang digunakan.…”

Section: Pembahasanunclassified

Peran Skor Kandida Sebagai Metode Diagnostik Kandidiasis Invasif Terhadap Neutropenia Berat pada Anak dengan Keganasan

Ratridewi

Juwita

Putera

et al. 2021

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Latar belakang. Infeksi kandidiasis invasif meliputi infeksi aliran darah dan infeksi invasif dalam lainnya yang disebabkan oleh spesies Kandida dan merupakan penyebab morbiditas dan mortalitas yang signifikan, khususnya pada pasien dengan status immunocompromised, seperti pada kondisi keganasan hematologis, kelainan limfoproliferatif, dan gangguan myeloproliferative.Tujuan. Menginvestigasi peran skor Kandida, dibandingkan dengan kultur darah dan PCR, sebagai alat diagnostik kandidiasis invasif pada pasien dengan neutropenia berat, khususnya pada kasus keganasan.Metode. Penelitian ini menggunakan desain penelitian cross sectional. Data yang diperoleh diolah dan dianalisis menggunakan metode Receiver operating characteristic (ROC) untuk mendapatkan nilai area under curve (AUC). Berdasarkan kurva AUC kemudian dilakukan pencarian titik potong yang paling optimal untuk mendapatkan nilai sensitivitas dan spesifisitasHasil. Hasil penelitian menunjukkan bahwa pada kedua kelompok dengan kultur positif dan negatif tidak didapatkan perbedaan bermakna berdasarkan karakteristik jenis kelamin, usia, berat badan, status gizi, dan diagnosis klinis (uji Mann-Whitney, p>0,05).Kesimpulan. Berdasarkan hasil tersebut, dapat disimpulkan bahwa tidak didapatkan perbedaan pada sensitivitas dan spesifisitas skor Kandida dibandingkan dengan hasil kultur pada pada pasien anak dengan neutropenia berat.

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“…Diagnosis of invasive candidiasis is not easy, either directly by means of cultures or indirectly by means of biomarkers or polymerase chain reaction [ 17 ].…”

Section: Introductionmentioning

confidence: 99%

Prophylaxis of Invasive Fungal Infection in Neonates: A Narrative Review for Practical Purposes

Ferrando

Castagnola

2023

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Candida albicans is the most frequent cause of invasive fungal disease in preterm and/or low birth weight neonates, followed by Candida parapsilosis, whilst infections from other species are rare. Considering the severity of the disease, associated with poor clinical signs and diagnostic difficulties, primary prophylaxis becomes relevant. This paper summarizes the pathogenesis and clinical presentation of invasive candidiasis in neonates, focusing on prophylaxis. For late onset invasive disease, e.g., those occurring after the 3rd (or 7th according to some definitions) day of life possible approaches are the use of fluconazole, recommended in case of weight <1000 g or <1500 g if the local incidence of invasive candidiasis is higher than 2%, or the use of nystatin (for patients < 1500 g). Micafungin must be used in case of colonization by Candida auris, or in centers with a high prevalence of this pathogen. Concurrently, correct management of the central venous catheter and isolation procedures, with special regard to patients colonized by resistant strains, are fundamental. Other approaches such as reduced use of H2 blockers and broad-spectrum antibiotics (e.g., 3rd generation cephalosporins or carbapenems) and promotion of breast feeding proved useful. Reduction of early-onset infections (those occurring in the first 3 days of life) can also be obtained by treating maternal vulvo–vaginal candidiasis, which can represent a fastidious problem during pregnancy. In this case, topic azoles (the only recommendable treatment) can represent a kind of “prophylaxis” of early neonatal candidiasis. However, it must always be remembered that prophylaxis reduces the risk of invasive candidiasis but can not completely eliminate its occurrence, with the parallel risk of selecting for antifungal-resistant strains. Clinicians must maintain a high level of suspicion to start an appropriate therapy and strict epidemiological surveillance to identify the occurrence of clusters and the appearance of strains resistant to prophylaxis.

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Diagnosis of invasive fungal disease in children: a narrative review

Cited by 6 publications

References 160 publications

Beta-D-Glucan in Patients with Haematological Malignancies

Beta-D-Glucan in Patients with Haematological Malignancies

Peran Skor Kandida Sebagai Metode Diagnostik Kandidiasis Invasif Terhadap Neutropenia Berat pada Anak dengan Keganasan

Prophylaxis of Invasive Fungal Infection in Neonates: A Narrative Review for Practical Purposes

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