Is there still a place for serum galactomannan in the diagnosis of invasive aspergillosis in children at high risk and under antifungal prophylaxis?

IF 4.1 2区医学 Q1 DERMATOLOGY Mycoses Pub Date : 2024-07-01 DOI:10.1111/myc.13764

Rémy Gerard, Frédéric Gabriel, Isabelle Accoceberry, Sébastien Imbert, Stéphane Ducassou, Marie Angoso, Charlotte Jubert

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Abstract

Background: The performance of serum galactomannan (GM) for the diagnosis of invasive aspergillosis (IA) has been studied mainly in adults. Paediatric data are scarce and based on small and heterogeneous cohorts.

Objective: To evaluate the performance of serum GM for the diagnosis of IA in a paediatric oncologic population at high risk of IA and to clarify the impact of antifungal prophylaxis on this test.

Methods: We performed a retrospective study from January 2014 to December 2020 in the paediatric oncologic haematologic department of the University Hospital of Bordeaux. The diagnosis of IA was made using the recommendations of the EORTC and the MSGERC.

Results: Among the 329 periods at high risk of IA in 222 patients, the prevalence of IA was 1.8% (3 proven and 3 probable IA). In the total population, the sensitivity, and the positive predictive value (PPV) were respectively 50% and 17.6%. Under antifungal prophylaxis, the sensitivity and PPV dropped, respectively, to 33.3% and 14.3%. In this group, the post-test probability of IA was 2% for a negative serum GM and only 14%.

Conclusion: In this large cohort of children at high risk of IA, the incidence of IA is low and the diagnostic performance of GM is poor, especially in the case of mould-active prophylaxis. Screening should be targeted rather than systematic and should be reserved for patients at highest risk for IA without mould-active prophylaxis. Combination with other tests such as Aspergillus PCR would increase the accuracy of GM in screening setting.

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血清半乳甘露聚糖在诊断高危和接受抗真菌预防治疗的儿童侵袭性曲霉菌病中是否仍有用武之地？

背景：血清半乳甘露聚糖（GM）诊断侵袭性曲霉菌病（IA）的性能主要在成人中进行了研究。儿科数据很少，而且是基于小规模的异质性队列：目的：评估血清 GM 在儿童肿瘤高危人群中诊断侵袭性曲霉病的效果，并明确抗真菌预防对该检测的影响：我们于2014年1月至2020年12月在波尔多大学医院儿科肿瘤血液科进行了一项回顾性研究。根据 EORTC 和 MSGERC 的建议对 IA 进行诊断：在222名患者的329个IA高危期中，IA的发病率为1.8%（3例证实为IA，3例可能为IA）。在所有人群中，灵敏度和阳性预测值（PPV）分别为 50%和 17.6%。在抗真菌预防措施下，灵敏度和 PPV 分别降至 33.3% 和 14.3%。在这组儿童中，血清 GM 阴性的 IA 检测后概率为 2%，而血清 GM 阳性的 IA 检测后概率仅为 14%：在这一大群高危儿童中，IA的发病率较低，而GM的诊断性能较差，尤其是在霉菌活性预防的情况下。筛查应具有针对性而非系统性，并应保留给未使用霉菌活性预防剂的IA高危患者。与曲霉菌 PCR 等其他检测方法相结合可提高 GM 在筛查中的准确性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Mycoses 医学-皮肤病学

CiteScore

10.00

自引率

8.20%

发文量

143

审稿时长

6-12 weeks

期刊介绍： The journal Mycoses provides an international forum for original papers in English on the pathogenesis, diagnosis, therapy, prophylaxis, and epidemiology of fungal infectious diseases in humans as well as on the biology of pathogenic fungi. Medical mycology as part of medical microbiology is advancing rapidly. Effective therapeutic strategies are already available in chemotherapy and are being further developed. Their application requires reliable laboratory diagnostic techniques, which, in turn, result from mycological basic research. Opportunistic mycoses vary greatly in their clinical and pathological symptoms, because the underlying disease of a patient at risk decisively determines their symptomatology and progress. The journal Mycoses is therefore of interest to scientists in fundamental mycological research, mycological laboratory diagnosticians and clinicians interested in fungal infections.