Artikel
Screening of paediatric allogeneic stem cell transplant recipients for invasive aspergillosis by using a combination of galactomannan and fungal DNA detection assays
Suche in Medline nach
Autoren
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J. Springer
- Medizinische Klinik & Poliklinik II, University Medical Center Würzburg, Würzburg, Germany
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J. Löffler
- Medizinische Klinik & Poliklinik II, University Medical Center Würzburg, Würzburg, Germany
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C. Wirth
- Department of Radiology, University Medical Center Würzburg, Würzburg, Germany
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C.P. Heussel
- Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany; Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
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A. Ullmann
- Medizinische Klinik & Poliklinik II, University Medical Center Würzburg, Würzburg, Germany
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H. Einsele
- Medizinische Klinik & Poliklinik II, University Medical Center Würzburg, Würzburg, Germany
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V. Wiegering
- Kinderklinik und Poliklinik, University Medical Center Würzburg, Würzburg, Germany
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M. Wölfl
- Kinderklinik und Poliklinik, University Medical Center Würzburg, Würzburg, Germany
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P.G. Schlegel
- Kinderklinik und Poliklinik, University Medical Center Würzburg, Würzburg, Germany
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M. Eyrich
- Kinderklinik und Poliklinik, University Medical Center Würzburg, Würzburg, Germany
| Veröffentlicht: | 13. März 2017 |
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Gliederung
Text
Invasive fungal infections with Aspergillus species, mostly Aspergillus fumigatus, are a frequently occurring event after allogeneic stem cell transplantation (alloSCT) also in the paediatric setting. As in adults, invasive aspergillosis (IA) in children is associated with a poor prognosis and requires intensive and prolonged treatment. Diagnostic workup of febrile pulmonary infections is usually difficult, as fungi poorly grow in microbial cultures. In adult patients, prospective screening of sera for the fungal cell wall component galactomannan (GM) and for DNA in parallel has resulted in increased diagnostic accuracy for IA. However, this approach has not been extensively evaluated in children so far. In this study, we included a biweekly screening for the presence of GM (by Platelia® ELISA) and a sensitive real time PCR assay into the routine microbial workup of 39 children shortly before or after stem cell transplantation. We prospectively collected in the mean n=14 blood specimens per patient (range: 6 to 33 specimens). In this cohort, we classified 4 probable and 2 possible cases of IA according to the current definitions of the EORTC/MSG resulting in an overall incidence of suspected IA of 15% [1]. Together with a clinical course highly suggestive for IA, all four probable cases exhibited simultaneous positive results in both test systems, whereas none of the possible or unclassified cases showed this pattern at any time. Interestingly, optical density values of GM assays were higher and positive intervals of these tests were substantially longer in children than in a comparable previous control group (adults after alloSCT) [2]. This indicates that combining both fungal test systems is of high diagnostic value also in the paediatric setting generating 100% sensitivity and 100% specificity in our cohort (Table 1 [Tab. 1]).
In summary, our data indicate that simultaneous prospective detection of GM and DNA in cell-free blood fraction is of high relevance also in the paediatric setting and can help to increase the diagnostic accuracy in febrile pulmonary infections after alloSCT.
References
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