Pediatric Hematology and Oncology, Hospital for Children and Adolescents, University of Frankfurt, Frankfurt, Germany.
Institute of Medical Microbiology, University Hospital Essen, Essen, Germany.
Sci Rep. 2019 Sep 10;9(1):12950. doi: 10.1038/s41598-019-49426-0.
Invasive mold disease (IMD) of the central nervous system (CNS) is a severe infectious complication in immunocompromised patients, but early microbiological diagnosis is difficult. As data on the value of biomarkers in the CNS are scarce, in particular in children, we retrospectively analyzed the performance of galactomannan (GM) and PCR assays in CNS samples of 15 children with proven and probable CNS IMD and of 32 immunocompromised children without fungal infection. Galactomannan in the cerebrospinal fluid (CSF) was assessed in nine of the 15 pediatric patients and was positive in five of them. Polymerase chain reaction (PCR) was performed in eight of the 15 patients and detected nucleic acids from molds in six patients. Galactomannan and PCR in CNS samples were the only positive microbiologic parameter in the CNS in three and two patients, respectively. In four patients, PCR specified the pathogen detected in microscopy. Galactomannan and PCR results remained negative in the CSF of all immunocompromised children without evidence for CNS IMD. Our data suggest that GM and PCR in CNS specimens are valuable additional tools in diagnosing CNS IMD and should be included in the work up of all pediatric patients with suspected mold disease of the CNS.
中枢神经系统（CNS）侵袭性霉菌病（IMD）是免疫功能低下患者严重的感染性并发症，但早期微生物学诊断较为困难。由于关于生物标志物在 CNS 中价值的数据很少，特别是在儿童中，我们回顾性分析了 15 例确诊和疑似 CNS IMD 患儿及 32 例无真菌感染免疫功能低下患儿 CNS 样本中 GM 和 PCR 检测的效能。15 例儿科患者中有 9 例进行了脑脊液（CSF）GM 检测，其中 5 例阳性。8 例患者进行了聚合酶链反应（PCR）检测，6 例患者检测到了霉菌的核酸。GM 和 PCR 是分别有 3 例和 2 例患者 CNS 唯一的阳性微生物学参数。4 例患者的 PCR 明确了显微镜下检测到的病原体。所有无 CNS IMD 证据的免疫功能低下患儿的 CSF GM 和 PCR 结果均为阴性。我们的数据表明，GM 和 CNS 样本中的 PCR 是诊断 CNS IMD 的有价值的附加工具，应纳入所有疑似 CNS 霉菌病患儿的检查中。
