Diagnostic Approaches for Invasive Aspergillosis—Specific Considerations in the Pediatric Population

Abstract

Invasive aspergillosis (IA) is a major cause of morbidity and mortality in children with hematological malignancies and those undergoing hematopoietic stem cell transplantation. Similar to immunocompromised adults, clinical signs, and symptoms of IA are unspecific in the pediatric patient population. As early diagnosis and prompt treatment of IA is associated with better outcome, imaging and non-invasive antigen-based such as galactomannan or ß-D-glucan and molecular biomarkers in peripheral blood may facilitate institution and choice of antifungal compounds and guide duration of therapy. In patients in whom imaging studies suggest IA or another mold infection, invasive diagnostics such as bronchoalveolar lavage and/or bioptic procedures should be considered. Here we review the current data of diagnostic approaches for IA in the pediatric setting and highlight the major differences of performance and clinical utility of the tests between children and adults.

1,3-Β-D-Glucan in Ifi Diagnostics

“…23,25 U nekoliko je istraživanja evaluirana primjena BDGa kod djece na kemoterapiji zbog malignih bolesti ili nakon transplantacije krvotvornih matičnih stanica te su nađene velike razlike u specifičnosti, osjetljivosti, pozitivnoj prediktivnoj vrijednosti (PPV) i negativnoj prediktivnoj vrijednosti (NPV) tog testa u ovoj po pulaciji bolesnika. 26,27,28 Zbog nedovoljno podataka o primjeni BDGa kod djece i potrebe da se tek validi raju specifične granične vrijednosti za pedijatrijsku populaciju trenutačno vrijedeće smjernice još ne pre poručuju primjenu ovoga fungalnog biomarkera kao rutinskoga dijagnostičkog testa, premda može poslu žiti u određenim situacijama uzimajući u obzir njego va ograničenja 6,23,29,30…”

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

“…Early detection and timely initiation of antifungal therapy is important for improved outcome, but diagnosis remains difficult, especially when relying on conventional microbiology methods such as microscopy and culture. Use of biomarkers for early diagnosis of IFD in high risk patients have been introduced over the last 2 decades [1]. Galactomannan (GM) and 1,3-β-D-glucan are used as adjunctive diagnostic tools in adults and are now incorporated into the diagnostic criteria of IFD established by the Invasive Fungal Infections Cooperative Group of the European Organization for Research and Treatment of Cancer (EORTC) and the Mycoses Study Group (MSG) [2].…”

Updated 2020 guidelines for diagnosis and treatment of invasive aspergillosis in children with hematologic malignancy

“…К этой группе относятся также пациенты с первичными иммунодефицитами (ПИД), такими как хроническая гранулематозная болезнь и дефект гена STAT, для которых характерно развитие ИГИ, в первую очередь ИА. Согласно моноцентровому исследованию наибольшая частота ИА встречалась у пациентов с первичными формами или рецидивами ОМЛ (до 28%), рецидивами ОЛЛ (9%) и первичными ОЛЛ (2%) [1][2][3][4].…”

“…Несмотря на улучшение возможностей профилактики и лечения, развитие ИА сопряжено с высокой смертностью, достигающей у детей с гемобластозами и реципиентов ТГСК 45-80% согласно различным исследованиям. У пациентов с ОМЛ и ОЛЛ развитие ИА может приводить к 5-кратному и 14-кратному увеличению смертности соответственно [2,3,5].…”

“…Поражение кожи и мягких тканей чаще наблюдается именно в детской популяции как следствие локальной травмы и контаминации либо гематогенной диссеминации ИА. Клинически кожные поражения могут варьировать от язвенных элементов до папулезных и инфильтративно-некротических изменений [2][3][4][6][7][8].…”