The Johns Hopkins Hospital, Department of Pharmacy, Baltimore, Maryland, USA.
The Johns Hopkins University School of Medicine, Department of Pediatrics, Division of Pediatric Infectious Diseases, Baltimore, Maryland, USA.
J Clin Microbiol. 2021 Aug 18;59(9):e0327620. doi: 10.1128/JCM.03276-20.
Establishing the diagnosis of invasive mold infections (IMI) in immunocompromised children is challenging due to nonspecific clinical presentations and the limited sensitivity of traditional culture-based methods. Rapid non-culture-based diagnostics such as the 1,3-beta-d-glucan and galactomannan assays have emerged as promising adjuncts to conventional diagnostic tests in adults. Available data suggest that 1,3-beta-d-glucan has limited accuracy in the pediatric population and is not recommended to be used for the diagnosis of IMI in children. On the other hand, the diagnostic performance of the serum and bronchoalveolar lavage galactomannan in immunocompromised children is comparable to results observed in adults and can be used as a screening tool in children at high risk of developing invasive aspergillosis (IA) who are not receiving mold-active antifungal prophylaxis and as a diagnostic tool in symptomatic children suspected of having IA. Herein, we summarize the available evidence for the use of these rapid non-culture-based diagnostics in immunocompromised children. We also summarize potential causes of false positivity for the 1,3-beta-d-glucan and galactomannan assays.
确立免疫功能低下儿童侵袭性霉菌感染（IMI）的诊断具有挑战性，因为其临床表现非特异性，且传统基于培养的方法灵敏度有限。1,3-β-D-葡聚糖和半乳甘露聚糖检测等快速非培养诊断方法已成为成人常规诊断检测的有前途的辅助手段。现有数据表明，1,3-β-D-葡聚糖在儿科人群中的准确性有限，不建议用于儿童 IMI 的诊断。另一方面，血清和支气管肺泡灌洗半乳甘露聚糖在免疫功能低下儿童中的诊断性能与在成人中观察到的结果相当，可用于未接受霉菌活性抗真菌预防且有发生侵袭性曲霉菌病（IA）高风险的儿童作为筛查工具，也可用于疑似患有 IA 的有症状儿童的诊断工具。在此，我们总结了这些快速非培养诊断方法在免疫功能低下儿童中的应用的现有证据。我们还总结了 1,3-β-D-葡聚糖和半乳甘露聚糖检测假阳性的潜在原因。
