Non-Invasive Methods to Diagnose Fungal Infections in Pediatric Patients with Hematologic Disorders

Abstract

BackgroundInvasive fungal infection (IFIs) is a major infectious complication in immunocompromised patients. Early diagnosis and initiation of antifungal therapy is important to achieve the best outcome.ObjectivesThe current study aimed to investigate the incidence of IFIs and evaluate the diagnostic performance of non-invasive laboratory tests: serologic (β-D-glucan, galactomannan) and molecular (nested polymerase chain reaction) tests to diagnose fungal infections in hematologic pediatric patients.Patients and MethodsIn a cross-sectional study from October 2014 to January 2015, 321 blood samples of 62 pediatric patients with hematologic disorders and at high risk for fungal infections were analyzed. Non-invasive tests including the Platelia Aspergillus enzyme immunoassay (EIA) to detect galactomannan antigen, Glucatell for β–D–glucan and nested PCR to detect Candida and Aspergillus species-specific DNA were used in a weekly screening strategy.ResultsTwenty six patients (42%) were considered as proven and probable IFIs, including 3 (5%) proven and 23 (37%) probable cases. Eighteen patients (29%) were considered as possible cases. The sensitivity, specificity, positive and negative predictive values for galactomannan test in 26 patients with proven and probable fungal infections were 94.4%, 100%, 100% and 94.7%; for β-D-glucan test 92.3%, 77.7%, 85%, 87.5% and for nested-PCR were 84.6%, 88.8%, 91.7% and 80%, respectively.ConclusionsThe rate of IFIs in pediatric patients with hematologic disorders is high, and sample collection from the sterile sites cannot be performed in immunocompromised patients. Detection of circulating fungal cell wall components and DNA in the blood using non-invasive methods can offer diagnostic help in patients with suspected IFIs. Their results should be interpreted in combination with clinical, radiological and microbiological findings.

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

“…Hingga saat ini belum ada protokol standar mengenai uji PCR, diversitas dari desain penelitian yang berbeda membuat sulit membandingkan hasil uji PCR antara penelitian satu dengan lainnya. 23 Teknik diagnostik berbasis asam nukleat merupakan uji deteksi DNA jamur yang memiliki sensitivitas tinggi dan memberikan hasil lebih cepat dibandingkan pendekatan diagnostik standar. Hal ini memudahkan dalam diagnosis inisiasi terapi antijamur yang lebih sesuai dan tepat waktu.…”

Harnessing the potential of CRISPR-based platforms to advance the field of hospital medicine

“…CRISPR-based tests carry several advantages over traditional microbiological diagnostics such as polymerase chain reaction (PCR), which is generally considered to be the most sensitive and specific test available for viral detection. However, PCR require multiple steps to run the assay, including an upfront nucleic acid extraction and amplification steps, and require dedicated instrumentation [30][31][32]. By contrast, CRISPR-Cas-based assays can be run directly on primary clinical samples as a single reaction and performed using minimal equipment [33][34][35][36].…”

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.…”