Lehrnbecher Thomas, Hassler Angela, Groll Andreas H, Bochennek Konrad
Division of Pediatric Hematology and Oncology, Hospital for Children and Adolescents, Johann Wolfgang Goethe-University, Frankfurt, Germany.
Infectious Disease Research Program, Center for Bone Marrow Transplantation, Department of Pediatric Hematology/Oncology, University Children's Hospital, Münster, Germany.
Front Microbiol. 2018 Mar 26;9:518. doi: 10.3389/fmicb.2018.00518. eCollection 2018.
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.
侵袭性曲霉病(IA)是血液系统恶性肿瘤患儿以及接受造血干细胞移植患儿发病和死亡的主要原因。与免疫功能低下的成人相似,IA在儿科患者群体中的临床体征和症状不具有特异性。由于IA的早期诊断和及时治疗与更好的预后相关,影像学检查以及外周血中基于半乳甘露聚糖或β-D-葡聚糖等非侵入性抗原和分子生物标志物的检测可能有助于抗真菌药物的选用及疗程的确定。对于影像学检查提示IA或其他霉菌感染的患者,应考虑进行侵入性诊断,如支气管肺泡灌洗和/或活检。在此,我们综述了儿科环境中IA诊断方法的当前数据,并强调了儿童和成人检测在性能和临床应用方面的主要差异。