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Choudhary H, Kaur H, Singh S, Singh R, Muthu V, Verma R, Rudramurthy SM, Agarwal R, Jain S, Bal A, Ghosh AK, Chakrabarti A. A novel indirect ELISA for serodiagnosis of mucormycosis using antigens from Rhizopus arrhizus. Mycoses 2024; 67:e13730. [PMID: 38712824 DOI: 10.1111/myc.13730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 04/22/2024] [Accepted: 04/24/2024] [Indexed: 05/08/2024]
Abstract
BACKGROUND Due to a delay in diagnosis by conventional techniques and high mortality, the development of a standardised and rapid non-culture-based technique is an unmet need in pulmonary, gastrointestinal, and disseminated forms of mucormycosis. Though limited studies have been conducted for molecular diagnosis, there are no established serologic tests for this highly fatal infection. OBJECTIVE To develop and evaluate an indirect in-house enzyme-linked immunosorbent assay (ELISA) utilising antigens of Rhizopus arrhizus for detecting anti-Rhizopus antibodies (IgG and IgM) in sera of patients with mucormycosis. METHODS We extracted both secretory and mycelial Rhizopus antigens using standardised protocols. Bradford assay was used for protein quantification. We then standardised an indirect ELISA using R. arrhizus mycelial and secretory antigens (10.0 μg/mL in bicarbonate buffer pH 9.2) for detecting anti-Rhizopus IgG and IgM antibodies in patient sera. We included patients with mucormycosis, other fungal infections, and healthy controls. Antibody index value (E-value) was calculated for each patient sample. RESULTS Asparagine broth culture filtrate utilising 85% ammonium sulphate salt fractionation and mycelial homogenate grown in yeast extract peptone dextrose (YPD) broth precipitated with trichloroacetic acid (TCA) yielded a large amount of good-quality protein for the assay. We included 55 patients with mucormycosis (rhino-orbito-cerebral mucormycosis [ROCM, n = 39], pulmonary [n = 15], gastrointestinal [n = 1]), 24 with other fungal infections (probable aspergillosis [n = 14], candidiasis [n = 10]), and healthy controls (n = 16). The sensitivity of the antibody test for diagnosing mucormycosis ranged from 83.6-92.7% for IgG and 72.7-87.3% for IgM, with a specificity of 91.7-92.5% for IgG and 80-82.5% for IgM. The sera from patients with other fungal infections and healthy individuals did not show significant cross-reactivity. CONCLUSION The detection of anti-Rhizopus IgG antibody performed significantly better in comparison to IgM-based ELISA for diagnosing both ROCM (sensitivity of 84.6% vs. 69.2%) and pulmonary cases (86.6% vs. 80.0%). More extensive studies are required to confirm our findings.
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Affiliation(s)
| | - Harsimran Kaur
- Department of Medical Microbiology, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Shreya Singh
- Department of Medical Microbiology, Dr. B. R. Ambedkar Institute of Medical Sciences, Mohali, Punjab, India
| | - Rachna Singh
- Department of Microbial Biotechnology, Panjab University, Chandigarh, India
| | - Valliappan Muthu
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Roshan Verma
- Department of Otolaryngology (ENT), Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Shivaprakash M Rudramurthy
- Department of Medical Microbiology, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Ritesh Agarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Sanjay Jain
- Department of Internal Medicine, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Amanjit Bal
- Department of Histopathology, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Anup K Ghosh
- Department of Medical Microbiology, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
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Shahid Z, Etra AM, Levine JE, Riches ML, Baluch A, Hill JA, Nakamura R, Toor AA, Ustun C, Young JAH, Perales MA, Epstein DJ, Murthy HS. Defining and Grading Infections in Clinical Trials Involving Hematopoietic Cell Transplantation: A Report From the BMT CTN Infectious Disease Technical Committee. Transplant Cell Ther 2024; 30:540.e1-540.e13. [PMID: 38458478 DOI: 10.1016/j.jtct.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 02/19/2024] [Accepted: 03/03/2024] [Indexed: 03/10/2024]
Abstract
The Blood and Marrow Transplant Clinical Trials Network (BMT-CTN) was established in 2001 to conduct large multi-institutional clinical trials addressing important issues towards improving the outcomes of HCT and other cellular therapies. Trials conducted by the network investigating new advances in HCT and cellular therapy not only assess efficacy but require careful capturing and severity assessment of adverse events and toxicities. Adverse infectious events in cancer clinical trials are typically graded according to the National Cancer Institute's Common Terminology Criteria for Adverse Events (CTCAE). However, there are limitations to this framework as it relates to HCT given the associated immunodeficiency and delayed immune reconstitution. The BMT-CTN Infection Grading System is a monitoring tool developed by the BMT CTN to capture and monitor infectious complications and differs from the CTCAE by its classification of infections based on their potential impact on morbidity and mortality for HCT recipients. Here we offer a report from the BMT CTN Infectious Disease Technical Committee regarding the rationale, development, and revising of BMT-CTN Infection Grading System and future directions as it applies to future clinical trials involving HCT and cellular therapy recipients.
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Affiliation(s)
- Zainab Shahid
- Department of Medicine, Infectious Disease Service, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York.
| | - Aaron M Etra
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - John E Levine
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Marcie L Riches
- Department of Medicine, Center for International Blood and Marrow Transplantation Research (CIBMTR), Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Aliyah Baluch
- Division of Infectious Diseases, Moffitt Cancer Center, Tampa, Florida
| | - Joshua A Hill
- Department of Medicine, University of Washington, WA and Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Wisconsin
| | - Ryo Nakamura
- Division of Hematology and HCT, City of Hope, Duarte, California
| | - Amir A Toor
- Lehigh Valley Health Network, Allentown, Pennsylvania
| | - Celalettin Ustun
- Division of Hematology, Oncology and Cell Therapy, Section of Bone Marrow Transplantation and Cellular Therapy, Rush Medical College, Chicago, Illinois
| | - Jo-Anne H Young
- Department of Medicine, Division of Infectious Disease and International Medicine, Program in Adult Transplant Infectious Disease, University of Minnesota, Minneapolis, Minnesota
| | - Miguel-Angel Perales
- Department of Medicine, Weill Cornell Medical College, New York, New York; Department of Medicine, Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center; Weill Cornell Medical College, New York, New York
| | - David J Epstein
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Hemant S Murthy
- Division of Hematology-Oncology, Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, Florida
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Ricci E, Bartalucci C, Russo C, Mariani M, Saffioti C, Massaccesi E, Pierri F, Brisca G, Moscatelli A, Caorsi R, Bruzzone B, Damasio MB, Marchese A, Mesini A, Castagnola E. Clinical and Radiological Features of Pneumocystis jirovecii Pneumonia in Children: A Case Series. J Fungi (Basel) 2024; 10:276. [PMID: 38667947 PMCID: PMC11050895 DOI: 10.3390/jof10040276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 03/27/2024] [Accepted: 04/04/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Pneumocytis jirovecii pneumonia (PJP) has high mortality rates in immunocompromised children, even though routine prophylaxis has decreased in incidence. The aim of this case series is to present the radiological and clinical pathway of PJP in a pediatric population. DESCRIPTION OF CASES All PJP cases in non-HIV/AIDS patients diagnosed at Istituto Giannina Gaslini Pediatric Hospital in Genoa (Italy) from January 2012 until October 2022 were retrospectively evaluated. Nine cases were identified (median age: 8.3 years), and of these, 6/9 underwent prophylaxis with trimethoprim/sulfamethoxazole (TMP/SMX; five once-a-week schedules and one three times-a-week schedule), while 3/9 did not receive this. PJP was diagnosed by real-time PCR for P. jirovecii-DNA in respiratory specimens in 7/9 cases and two consecutive positive detections of β-d-glucan (BDG) in the serum in 2/9 cases. Most patients (6/8) had a CT scan with features suggestive of PJP, while one patient did not undergo a scan. All patients were treated with TMP/SMX after a median time from symptoms onset of 3 days. In 7/9 cases, empirical TMP/SMX treatment was initiated after clinical suspicion and radiological evidence and later confirmed by microbiological data. Clinical improvement with the resolution of respiratory failure and 30-day survival included 100% of the study population. DISCUSSION Due to the difficulty in obtaining biopsy specimens, PJP diagnosis is usually considered probable in most cases. Moreover, the severity of the clinical presentation often leads physicians to start TMP/SMX treatment empirically. BDG proved to be a useful tool for diagnosis, and CT showed good accuracy in identifying typical patterns. In our center, single-day/week prophylaxis was ineffective in high-risk patients; the three-day/week schedule would, therefore, seem preferable and, in any case, should be started promptly in all patients who have an indication of pneumonia.
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Affiliation(s)
- Erica Ricci
- Division of Infectious Diseases, IRCCS Istituto Giannina Gaslini, Via Gerolamo Gaslini 5, 16147 Genoa, Italy; (E.R.); (C.R.); (C.S.); (E.C.)
| | - Claudia Bartalucci
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genoa, 16132 Genoa, Italy;
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Chiara Russo
- Division of Infectious Diseases, IRCCS Istituto Giannina Gaslini, Via Gerolamo Gaslini 5, 16147 Genoa, Italy; (E.R.); (C.R.); (C.S.); (E.C.)
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova, 16132 Genoa, Italy
| | - Marcello Mariani
- Division of Infectious Diseases, IRCCS Istituto Giannina Gaslini, Via Gerolamo Gaslini 5, 16147 Genoa, Italy; (E.R.); (C.R.); (C.S.); (E.C.)
| | - Carolina Saffioti
- Division of Infectious Diseases, IRCCS Istituto Giannina Gaslini, Via Gerolamo Gaslini 5, 16147 Genoa, Italy; (E.R.); (C.R.); (C.S.); (E.C.)
| | - Erika Massaccesi
- Division of Ematology, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Filomena Pierri
- Unit of Bone Marrow Transplantation, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Giacomo Brisca
- Division of Neonatal and Pediatric Critical Care and Semi-Intensive Care, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy; (G.B.); (A.M.)
| | - Andrea Moscatelli
- Division of Neonatal and Pediatric Critical Care and Semi-Intensive Care, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy; (G.B.); (A.M.)
| | - Roberta Caorsi
- Center for Autoinflammatory Diseases and Immunodeficiencies, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Bianca Bruzzone
- Hygiene Unit, Department of Health Sciences, Ospedale Policlinico San Martino, University of Genoa, 16132 Genoa, Italy
| | | | - Anna Marchese
- Microbiology Unit, Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, 16132 Genoa, Italy;
| | - Alessio Mesini
- Division of Infectious Diseases, IRCCS Istituto Giannina Gaslini, Via Gerolamo Gaslini 5, 16147 Genoa, Italy; (E.R.); (C.R.); (C.S.); (E.C.)
| | - Elio Castagnola
- Division of Infectious Diseases, IRCCS Istituto Giannina Gaslini, Via Gerolamo Gaslini 5, 16147 Genoa, Italy; (E.R.); (C.R.); (C.S.); (E.C.)
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Whitehurst DA, Friedman DL, Zhao Z, Sarma A, Snyder E, Dulek DE, Banerjee R, Kitko CL, Esbenshade AJ. A comprehensive assessment of the prolonged febrile neutropenia evaluation in pediatric oncology patients. Pediatr Blood Cancer 2024; 71:e30818. [PMID: 38110594 DOI: 10.1002/pbc.30818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 11/14/2023] [Accepted: 12/01/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND Pediatric oncology patients with prolonged (≥96 hours) febrile neutropenia (absolute neutrophil count < 500/μL) often undergo an evaluation for invasive fungal disease (IFD) and other infections. Current literature suggests that beta-D-glucan (BDG), galactomannan, bronchoalveolar lavage (BAL), and computed tomography (CT) scans (sinus, chest, and abdomen/pelvis) may help determine a diagnosis in this population. METHODS In a retrospective cohort study of all cancer/stem cell transplant patients (diagnosed 2005-2019) from one pediatric hospital, all episodes with prolonged febrile neutropenia or IFD evaluations (defined as sending a fungal biomarker or performing a CT scan to assess for infection) were identified. RESULTS In total, 503 episodes met inclusion criteria and 64% underwent IFD evaluations. In total, 36.4% of episodes documented an infection after initiation of prolonged febrile evaluation, most commonly Clostridioides difficile colitis (6.4%) followed by a true bacterial bloodstream infection (BSI) (5.2%), proven/probable IFD (4.8%), and positive respiratory pathogen panel (3.6%). There was no difference in sinus CTs showing sinusitis (74% vs 63%, p = 0.46), whereas 32% of abdomen/pelvis CTs led to a non-IFD diagnosis, and 25% of chest CTs showed possible pneumonia. On chest CT, the positive predictive value (PPV) for IFD was 19% for nodules and 14% for tree and bud lesions. BDG had a PPV of 25% for IFD and GM 50%. BAL diagnosed IFD once and pneumocystis jirovecii pneumonia twice. CONCLUSIONS Chest CTs and abdomen/pelvis CTs provide clinically relevant information during the prolonged febrile neutropenia evaluation, whereas BDG, galactomannan, BAL, and sinus CTs have less certain utility.
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Affiliation(s)
| | - Debra L Friedman
- School of Medicine, Vanderbilt University, Nashville, Tennessee, USA
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Division of Pediatric Hematology-Oncology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, USA
| | - Zhiguo Zhao
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Asha Sarma
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Elizabeth Snyder
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Daniel E Dulek
- School of Medicine, Vanderbilt University, Nashville, Tennessee, USA
- Division of Pediatric Infectious Diseases, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, USA
| | - Ritu Banerjee
- School of Medicine, Vanderbilt University, Nashville, Tennessee, USA
- Division of Pediatric Infectious Diseases, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, USA
| | - Carrie L Kitko
- School of Medicine, Vanderbilt University, Nashville, Tennessee, USA
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Division of Pediatric Hematology-Oncology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, USA
| | - Adam J Esbenshade
- School of Medicine, Vanderbilt University, Nashville, Tennessee, USA
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Division of Pediatric Hematology-Oncology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, USA
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Aerts R, Feys S, Mercier T, Lagrou K. Microbiological Diagnosis of Pulmonary Aspergillus Infections. Semin Respir Crit Care Med 2024; 45:21-31. [PMID: 38228164 DOI: 10.1055/s-0043-1776777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
As microbiological tests play an important role in our diagnostic algorithms and clinical approach towards patients at-risk for pulmonary aspergillosis, a good knowledge of the diagnostic possibilities and especially their limitations is extremely important. In this review, we aim to reflect critically on the available microbiological diagnostic modalities for diagnosis of pulmonary aspergillosis and formulate some future prospects. Timely start of adequate antifungal treatment leads to a better patient outcome, but overuse of antifungals should be avoided. Current diagnostic possibilities are expanding, and are mainly driven by enzyme immunoassays and lateral flow device tests for the detection of Aspergillus antigens. Most of these tests are directed towards similar antigens, but new antibodies towards different targets are under development. For chronic forms of pulmonary aspergillosis, anti-Aspergillus IgG antibodies and precipitins remain the cornerstone. More studies on the possibilities and limitations of molecular testing including targeting resistance markers are ongoing. Also, metagenomic next-generation sequencing is expanding our future possibilities. It remains important to combine different test results and interpret them in the appropriate clinical context to improve performance. Test performances may differ according to the patient population and test results may be influenced by timing, the tested matrix, and prophylactic and empiric antifungal therapy. Despite the increasing armamentarium, a simple blood or urine test for the diagnosis of aspergillosis in all patient populations at-risk is still lacking. Research on diagnostic tools is broadening from a pathogen focus on biomarkers related to the patient and its immune system.
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Affiliation(s)
- Robina Aerts
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
- Department of Internal Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Simon Feys
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
- Medical Intensive Care Unit, University Hospitals Leuven, Leuven, Belgium
| | - Toine Mercier
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
- Department of Oncology-Hematology, AZ Sint-Maarten, Mechelen, Belgium
| | - Katrien Lagrou
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
- Department of Laboratory Medicine and National Reference Center for Mycosis, University Hospitals Leuven, Leuven, Belgium
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Yeoh DK, McMullan BJ, Clark JE, Slavin MA, Haeusler GM, Blyth CC. The Challenge of Diagnosing Invasive Pulmonary Aspergillosis in Children: A Review of Existing and Emerging Tools. Mycopathologia 2023; 188:731-743. [PMID: 37040020 PMCID: PMC10564821 DOI: 10.1007/s11046-023-00714-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 02/07/2023] [Indexed: 04/12/2023]
Abstract
Invasive pulmonary aspergillosis remains a major cause of morbidity and mortality for immunocompromised children, particularly for patients with acute leukaemia and those undergoing haematopoietic stem cell transplantation. Timely diagnosis, using a combination of computed tomography (CT) imaging and microbiological testing, is key to improve prognosis, yet there are inherent challenges in this process. For CT imaging, changes in children are generally less specific than those reported in adults and recent data are limited. Respiratory sampling by either bronchoalveolar lavage or lung biopsy is recommended but is not always feasible in children, and serum biomarkers, including galactomannan, have important limitations. In this review we summarise the current paediatric data on available diagnostic tests for IPA and highlight key emerging diagnostic modalities with potential for future use.
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Affiliation(s)
- Daniel K Yeoh
- Department of Infectious Diseases, Perth Children's Hospital, 15 Hospital Avenue, Perth, WA, 6009, Australia.
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC, Australia.
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.
- Murdoch Children's Research Institute, Parkville, VIC, Australia.
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia.
| | - Brendan J McMullan
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC, Australia
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, NSW, Australia
- School of Women's and Children's Health, UNSW, Sydney, NSW, Australia
| | - Julia E Clark
- Infection Management Service, Queensland Children's Hospital, Brisbane, QLD, Australia
- School of Clinical Medicine, Children's Health Queensland Clinical Unit, The University of Queensland, Brisbane, QLD, Australia
| | - Monica A Slavin
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC, Australia
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Gabrielle M Haeusler
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC, Australia
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Murdoch Children's Research Institute, Parkville, VIC, Australia
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Department of Infectious Diseases, Royal Children's Hospital, Parkville, VIC, Australia
- The Paediatric Integrated Cancer Service, Melbourne, VIC, Australia
| | - Christopher C Blyth
- Department of Infectious Diseases, Perth Children's Hospital, 15 Hospital Avenue, Perth, WA, 6009, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
- Department of Microbiology, PathWest Laboratory Medicine WA, Nedlands, WA, Australia
- School of Medicine, University of Western Australia, Perth, WA, Australia
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Aerts R, Cuypers L, Mercier T, Maertens J, Lagrou K. Implementation of Lateral Flow Assays for the Diagnosis of Invasive Aspergillosis in European Hospitals: A Survey from Belgium and a Literature Review of Test Performances in Different Patient Populations. Mycopathologia 2023; 188:655-665. [PMID: 37209228 DOI: 10.1007/s11046-023-00739-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 04/15/2023] [Indexed: 05/22/2023]
Abstract
OBJECTIVES Diagnosis of invasive aspergillosis is based on a combination of criteria, of which the detection of Aspergillus galactomannan (GM) often is decisive. To date, the most commonly used method to determine GM is an enzyme-linked immune assay (EIA). But since a few years lateral flow assays (LFAs) were introduced, providing the possibility for rapid single sample testing. More and more LFAs are entering the market, but, although often being equated, all use their own antibodies, procedures and interpretation criteria. A recent European survey revealed that about 24-33% of laboratories implemented a lateral flow assay on-site. METHODS We conducted a survey at 81 Belgian hospital laboratories regarding the implementation of LFAs in their centre. In addition, we performed an extensive review of all publicly available studies on the performance of lateral flow assays to diagnose invasive aspergillosis. RESULTS Response rate to the survey was 69%. Of the 56 responding hospital laboratories, 6 (11%) used an LFA. The Soña Aspergillus galactomannan LFA (IMMY, Norman, Oklahoma, USA) was used in 4/6 centres, while two centres used the QuicGM (Dynamiker, Tianjin, China) and one centre used the FungiXpert Aspergillus Galactomannan Detection K-set LFA (Genobio [Era Biology Technology], Tianjin, China). One centre used 2 distinct LFAs. In 3/6 centres, the sample is sent to another lab for confirmation with GM-EIA when the LFA result is positive and in 2/6 when the LFA results is negative. In one centre, a confirmatory GM-EIA is always performed in house. In three centres the LFA result is used as a complete substitute for GM-EIA. Available LFA performance studies are very diverse and results vary in function of the study population and type of LFA. Apart from the IMMY and OLM LFA, only very limited performance data are available. From two out of three LFAs used in Belgium, no clinical performance studies are published in literature. CONCLUSIONS A large variety of LFAs are used in Belgian Hospitals, some of which no clinical validation studies are published. These results do likely have implications for other parts of Europe and for the rest of the world as well. Due to the variable performance of LFA tests and the limited validation data available, each laboratory must check the available performance information of the specific test considered for implementation. In addition, laboratories should perform an implementation verification study.
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Affiliation(s)
- Robina Aerts
- Department of Internal Medicine, University Hospitals Leuven, Leuven, Belgium
- Laboratory of Clinical Microbiology, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Lize Cuypers
- Laboratory of Clinical Microbiology, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
- Department of Laboratory Medicine, National Reference Center for Mycosis, University Hospitals Leuven, Leuven, Belgium
| | - Toine Mercier
- Laboratory of Clinical Microbiology, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
- Department of Haematology, General Hospital Sint-Maarten, Mechelen, Belgium
| | - Johan Maertens
- Laboratory of Clinical Microbiology, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
- Department of Haematology, University Hospitals Leuven, Leuven, Belgium
| | - Katrien Lagrou
- Laboratory of Clinical Microbiology, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium.
- Department of Laboratory Medicine, National Reference Center for Mycosis, University Hospitals Leuven, Leuven, Belgium.
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Cruciani M, White PL, Barnes RA, Loeffler J, Donnelly JP, Rogers TR, Heinz WJ, Warris A, Morton CO, Lengerova M, Klingspor L, Sendid B, Lockhart DEA. An Overview of Systematic Reviews of Polymerase Chain Reaction (PCR) for the Diagnosis of Invasive Aspergillosis in Immunocompromised People: A Report of the Fungal PCR Initiative (FPCRI)-An ISHAM Working Group. J Fungi (Basel) 2023; 9:967. [PMID: 37888223 PMCID: PMC10607919 DOI: 10.3390/jof9100967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 09/11/2023] [Accepted: 09/22/2023] [Indexed: 10/28/2023] Open
Abstract
This overview of reviews (i.e., an umbrella review) is designed to reappraise the validity of systematic reviews (SRs) and meta-analyses related to the performance of Aspergillus PCR tests for the diagnosis of invasive aspergillosis in immunocompromised patients. The methodological quality of the SRs was assessed using the AMSTAR-2 checklist; the quality of the evidence (QOE) within each SR was appraised following the GRADE approach. Eight out of 12 SRs were evaluated for qualitative and quantitative assessment. Five SRs evaluated Aspergillus PCR on bronchoalveolar lavage fluid (BAL) and three on blood specimens. The eight SRs included 167 overlapping reports (59 evaluating PCR in blood specimens, and 108 in BAL), based on 107 individual primary studies (98 trials with a cohort design, and 19 with a case-control design). In BAL specimens, the mean sensitivity and specificity ranged from 0.57 to 0.91, and from 0.92 to 0.97, respectively (QOE: very low to low). In blood specimens (whole blood or serum), the mean sensitivity ranged from 0.57 to 0.84, and the mean specificity from 0.58 to 0.95 (QOE: low to moderate). Across studies, only a low proportion of AMSTAR-2 critical domains were unmet (1.8%), demonstrating a high quality of methodological assessment. Conclusions. Based on the overall methodological assessment of the reviews included, on average we can have high confidence in the quality of results generated by the SRs.
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Affiliation(s)
| | - P. Lewis White
- Public Health Wales, Microbiology Cardiff, UK and Centre for Trials Research, Division of Infection and Immunity, Cardiff University, Cardiff CF14 4XW, UK;
| | | | - Juergen Loeffler
- Department of Internal Medicine II, University Hospital of Würzburg, 97070 Würzburg, Germany
| | | | - Thomas R. Rogers
- Discipline of Clinical Microbiology, Trinity College Dublin, St. James’s Hospital Campus, LS9 7TF Dublin, Ireland;
| | - Werner J. Heinz
- Medicine Clinic II, Caritas Hospital Bad Mergentheim, 97980 Bad Mergentheim, Germany
| | - Adilia Warris
- MRC Centre for Medical Mycology, University of Exeter, Exeter EX4 4QJ, UK;
| | - Charles Oliver Morton
- School of Science, Western Sydney University, Campbelltown Campus, Campbelltown, NSW 2751, Australia;
| | - Martina Lengerova
- Central European Institute of Technology, Masaryk University, 60177 Brno, Czech Republic
| | - Lena Klingspor
- Department of Laboratory Medicine, Karolinska Institutet, 17177 Stockholm, Sweden;
| | - Boualem Sendid
- Inserm U1285, CNRS UMR 8576, UGSF, CHU Lille, Laboratoire de Parasitologie-Mycologie, University of Lille, 59000 Lille, France;
| | - Deborah E. A. Lockhart
- Institute of Medical Sciences, School of Medicine Medical Sciences and Nutrition, University of Aberdeen, Aberdeen AB24 3FX, UK
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9
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Bochennek K, Barnbrock A, Lehrnbecher T. Nonculture Diagnostics in Invasive Fungal Infections in Children. Pediatr Infect Dis J 2023; 42:e333-e335. [PMID: 37409829 DOI: 10.1097/inf.0000000000004043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Affiliation(s)
- Konrad Bochennek
- From the Department of Pediatrics, Division of Hematology, Oncology and Hemostaseology, Goethe University Frankfurt, Frankfurt, Germany
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10
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Arrieta AC, Lee A, Tran MT. Invasive Mold Infections in Children: Navigating Troubled Waters with a Broken Compass. Infect Dis Ther 2023:10.1007/s40121-023-00819-9. [PMID: 37209297 DOI: 10.1007/s40121-023-00819-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 05/03/2023] [Indexed: 05/22/2023] Open
Abstract
Incidence of invasive mold infections in children, while rare, is increasing as the population of high-risk patients expands, including premature infants, pediatric patients undergoing treatment for hematological malignancies, or recipients of allogeneic hematologic stem cell transplants. The infectious agents, including Aspergillus spp., Mucorales, and other molds, are especially difficult to treat and have serious morbidity and high mortality. Clinicians must maintain a high index of suspicion for invasive mold infections in at-risk patients. Diagnosis of invasive mold infections is complicated by difficulties isolating pathogens on culture, but progress is being made in immunological and molecular diagnostic technologies. Treatment in children is challenging; no randomized controlled trials exist. There is a growing body of data on treatment, specifically on safer antifungal agents, including indications for treatment, spectrum of coverage, pharmacokinetics for different ages, and pharmacodynamic targets associated with therapeutic success. However, pediatricians must often extrapolate from adult data. In this review, we aim to harmonize the existing body of literature on invasive mold infections in children, covering epidemiology, clinical presentations, diagnostic methods, and principles of management.
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Affiliation(s)
- Antonio C Arrieta
- Department of Infectious Diseases, Children's Hospital of Orange County, Orange, CA, USA
- Department of Pediatrics, University of California, Irvine, School of Medicine, Irvine, CA, USA
| | - Adam Lee
- Department of Infectious Diseases, Children's Hospital of Orange County, Orange, CA, USA.
| | - M Tuan Tran
- Department of Pharmacy, Children's Hospital of Orange County, Orange, CA, USA
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11
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Pana ZD, Groll AH, Lehrnbecher T. An Update on the Diagnosis and Treatment of Invasive Mold Disease of the Central Nervous System in Children. Pediatr Infect Dis J 2023; 42:e119-e121. [PMID: 36730048 DOI: 10.1097/inf.0000000000003780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Epidemiological data of CNS IMD in pediatrics are limited. Aspergillus is the most frequently identified species, followed by other rare molds. Prompt diagnosis is of importance to define the optimal therapeutic management with respect to antifungal agent, dose, and evaluation of surgical intervention. The mortality rate of CNS IMD remains high. In this mini review we summarize the current knowledge on diagnosis and treatment of CNS IMD in pediatrics.
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Affiliation(s)
| | - Andreas H Groll
- Infectious Disease Research Program, Center for Bone Marrow Transplantation and Department of Pediatric Hematology and Oncology, University Children's Hospital of Münster, Münster, Germany
| | - Thomas Lehrnbecher
- Pediatric Hematology and Oncology, Hospital for Children and Adolescents, University Hospital, Goethe University, Frankfurt, Germany
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12
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Ricard N, Zebali L, Renard C, Goutagny MP, Benezech S, Bertrand Y, Philippe M, Domenech C. New Perspectives on Primary Prophylaxis of Invasive Fungal Infection in Children Undergoing Hematopoietic Stem Cell Transplantation: A 10-Year Retrospective Cohort Study. Cancers (Basel) 2023; 15:cancers15072107. [PMID: 37046769 PMCID: PMC10093632 DOI: 10.3390/cancers15072107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/26/2023] [Accepted: 03/26/2023] [Indexed: 04/03/2023] Open
Abstract
Background: Allogenic hematopoietic stem cell transplantation (a-HCT) remains a therapeutic treatment for many pediatric hematological diseases. The occurrence of invasive fungal infections (IFIs) is a complication for which ECIL-8 recommends primary antifungal prophylaxis. In this study, we evaluated the impact of our local strategy of not systematically administering primary antifungal prophylaxis in children undergoing a-HCT on the occurrence and mortality of IFIs. Methods: We performed a retrospective monocentric study from 2010 to 2020. We retained all proven and probable IFIs diagnosed during the first year post a-HCT. Results: 308 patients were included. Eighteen patients developed twenty IFIs (thirteen proven, seven probable) (6.5%) among which aspergillosis (n = 10, 50%) and candidosis (n = 7, 35%) were the most frequently diagnosed infections. Only 2% of children died because of an IFI, which represents 14% of all deaths. Multivariate analysis found that age > 10 years (OR: 0.29), the use of a therapeutic antiviral treatment (OR: 2.71) and a low neutrophil count reconstitution (OR: 0.93) were significantly associated with the risk of IFI occurrence. There was also a trend of malignant underlying disease and status ≥ CR2 but it was not retained in multivariate analysis. Conclusions: IFI occurrence was not higher in our cohort than what is reported in the literature with the use of systematic antifungal prophylaxis, with a good survival rate nonetheless. Thus, a prophylaxis could be considered for children with a high risk of IFI such as those aged over 10 years.
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Affiliation(s)
- Noémi Ricard
- Centre Léon Bérard, Pharmacy Department, 69008 Lyon, France
| | - Lelia Zebali
- The Pediatric Hematology and Oncology Institute, Hospices Civils de Lyon, Université Lyon 1, 69008 Lyon, France; (L.Z.)
| | - Cécile Renard
- The Pediatric Hematology and Oncology Institute, Hospices Civils de Lyon, Université Lyon 1, 69008 Lyon, France; (L.Z.)
| | - Marie-Pierre Goutagny
- The Pediatric Hematology and Oncology Institute, Hospices Civils de Lyon, Université Lyon 1, 69008 Lyon, France; (L.Z.)
| | - Sarah Benezech
- The Pediatric Hematology and Oncology Institute, Hospices Civils de Lyon, Université Lyon 1, 69008 Lyon, France; (L.Z.)
| | - Yves Bertrand
- The Pediatric Hematology and Oncology Institute, Hospices Civils de Lyon, Université Lyon 1, 69008 Lyon, France; (L.Z.)
- Faculty of Medicine Lyon Est, Université Claude Bernard Lyon 1, 69008 Lyon, France
| | - Michael Philippe
- Centre Léon Bérard, Pharmacy Department, 69008 Lyon, France
- The Pediatric Hematology and Oncology Institute, Hospices Civils de Lyon, Université Lyon 1, 69008 Lyon, France; (L.Z.)
| | - Carine Domenech
- The Pediatric Hematology and Oncology Institute, Hospices Civils de Lyon, Université Lyon 1, 69008 Lyon, France; (L.Z.)
- Faculty of Medicine and Maieutics Charles Mérieux Lyon Sud, Université Claude Bernard Lyon 1, 69921 Lyon, France
- International Center of Research in Infectiology, Université Lyon 1, INSERM U 1111, CNRS UMR 5308, 69007 Lyon, France
- Correspondence: ; Tel.: +33-469-166-567; Fax: +33-478-782-703
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13
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Lehrnbecher T, Bochennek K, Groll AH. Mold-Active Antifungal Prophylaxis in Pediatric Patients with Cancer or Undergoing Hematopoietic Cell Transplantation. J Fungi (Basel) 2023; 9:jof9030387. [PMID: 36983555 PMCID: PMC10059906 DOI: 10.3390/jof9030387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 03/18/2023] [Accepted: 03/21/2023] [Indexed: 03/30/2023] Open
Abstract
Invasive fungal diseases (IFDs), in particular invasive mold infections, still pose considerable problems in the care of children and adolescents treated for cancer or undergoing hematopoietic cell transplantation. As these infections are difficult to diagnose, and the outcomes for IFDs are still unsatisfactory, antifungal prophylaxis has become an important strategy in the clinical setting. Antifungal prophylaxis is indicated in patients at high risk for IFD, which is commonly defined as a natural incidence of at least 10%. As there is a growing interest in pediatric-specific clinical trials and pediatric-specific guidelines, this review focuses on the available data of mold-active antifungal prophylaxis in children and adolescents. The data demonstrate that a major effort is needed to characterize the pediatric patient population in which the net effect of prophylactic antifungals will be beneficial as well as to find the optimal prophylactic antifungal compound and dosage.
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Affiliation(s)
- Thomas Lehrnbecher
- Division of Pediatric Hematology and Oncology, Hospital for Children and Adolescents, University Hospital, Johann Wolfgang Goethe University, 60589 Frankfurt am Main, Germany
| | - Konrad Bochennek
- Division of Pediatric Hematology and Oncology, Hospital for Children and Adolescents, University Hospital, Johann Wolfgang Goethe University, 60589 Frankfurt am Main, Germany
| | - Andreas H Groll
- Infectious Disease Research Program, Center for Bone Marrow Transplantation, Department of Pediatric Hematology/Oncology, University Children's Hospital, 48149 Muenster, Germany
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14
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Lehrnbecher T, Robinson PD, Ammann RA, Fisher B, Patel P, Phillips R, Beauchemin MP, Carlesse F, Castagnola E, Davis BL, Elgarten CW, Groll AH, Haeusler GM, Koenig C, Santolaya ME, Tissing WJ, Wolf J, Alexander S, Hu H, Dupuis LL, Sung L. Guideline for the Management of Fever and Neutropenia in Pediatric Patients With Cancer and Hematopoietic Cell Transplantation Recipients: 2023 Update. J Clin Oncol 2023; 41:1774-1785. [PMID: 36689694 PMCID: PMC10022858 DOI: 10.1200/jco.22.02224] [Citation(s) in RCA: 31] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/09/2022] [Accepted: 12/13/2022] [Indexed: 01/24/2023] Open
Abstract
PURPOSE To update a clinical practice guideline (CPG) for the empiric management of fever and neutropenia (FN) in pediatric patients with cancer and hematopoietic cell transplantation recipients. METHODS The International Pediatric Fever and Neutropenia Guideline Panel reconvened to conduct the second update of this CPG. We updated the previous systematic review to identify new randomized controlled trials (RCTs) evaluating any strategy for the management of FN in pediatric patients. Using the Grading of Recommendations Assessment, Development and Evaluation framework, evidence quality was classified as high, moderate, low, or very low. The panel updated recommendations related to initial management, ongoing management, and empiric antifungal therapy. Changes from the 2017 CPG were articulated, and good practice statements were considered. RESULTS We identified 10 new RCTs in addition to the 69 RCTs identified in previous FN CPGs to inform the 2023 FN CPG. Changes from the 2017 CPG included two conditional recommendations regarding (1) discontinuation of empiric antibacterial therapy in clinically well and afebrile patients with low-risk FN if blood cultures remain negative at 48 hours despite no evidence of marrow recovery and (2) pre-emptive antifungal therapy for invasive fungal disease in high-risk patients not receiving antimold prophylaxis. The panel created a good practice statement to initiate FN CPG-consistent empiric antibacterial therapy as soon as possible in clinically unstable febrile patients. CONCLUSION The updated FN CPG incorporates important modifications on the basis of recently published trials. Future work should focus on addressing knowledge gaps, improving CPG implementation, and measuring the impact of CPG-consistent care.
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Affiliation(s)
- Thomas Lehrnbecher
- Pediatric Hematology and Oncology, Hospital for Children and Adolescents, Johann Wolfgang Goethe University, Frankfurt, Germany
| | | | - Roland A. Ammann
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Inselspital, Bern University Hospital, Bern, Switzerland
- Kinderaerzte KurWerk, Burgdorf, Switzerland
| | - Brian Fisher
- Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Priya Patel
- Pediatric Oncology Group of Ontario, Toronto, Canada
- Department of Pharmacy, The Hospital for Sick Children, Toronto, Canada
| | - Robert Phillips
- Department of Haematology and Oncology, Leeds Teaching Hospital, NHS Trust, Leeds, United Kingdom
| | - Melissa P. Beauchemin
- Columbia University/Herbert Irving Cancer Center, Columbia University School of Nursing, New York, NY
| | - Fabianne Carlesse
- Pediatric Oncology Institute, GRAACC/Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Elio Castagnola
- Infectious Diseases Unit, Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | | | | | - Andreas H. Groll
- Infectious Disease Research Program, Center for Bone Marrow Transplantation, Department of Pediatric Hematology/Oncology, University Children's Hospital, Muenster, Germany
| | - Gabrielle M. Haeusler
- Department of Infectious Diseases, Royal Children's Hospital, Melbourne, Australia
- Department of Infectious Diseases, Peter MacCallum Cancer Center, Melbourne, Australia
- NHMRC National Center for Infections in Cancer, Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia
| | - Christa Koenig
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Inselspital, Bern University Hospital, Bern, Switzerland
- Kinderaerzte KurWerk, Burgdorf, Switzerland
| | - Maria E. Santolaya
- Department of Pediatrics, Hospital Dr Luis Calvo Mackenna, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Wim J.E. Tissing
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Department of Pediatric Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Joshua Wolf
- Division of Infectious Disease, St Jude Children's Research Hospital, Memphis, TN
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN
| | - Sarah Alexander
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Helen Hu
- Pediatric Oncology Group of Ontario, Toronto, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
| | - L. Lee Dupuis
- Department of Pharmacy, The Hospital for Sick Children, Toronto, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Canada
| | - Lillian Sung
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Canada
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15
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Otto WR, Dvorak CC, Boge CLK, Ostrosky-Zeichner L, Esbenshade AJ, Nieder ML, Alexander S, Steinbach WJ, Dang H, Villaluna D, Chen L, Skeens M, Zaoutis TE, Sung L, Fisher BT. Prospective Evaluation of the Fungitell® (1→3) Beta-D-Glucan Assay as a Diagnostic Tool for Invasive Fungal Disease in Pediatric Allogeneic Hematopoietic Cell Transplantation: A Report from the Children's Oncology Group. Pediatr Transplant 2023; 27:e14399. [PMID: 36299233 PMCID: PMC9885553 DOI: 10.1111/petr.14399] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 09/06/2022] [Accepted: 09/12/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Invasive fungal disease (IFD) is a major source of morbidity and mortality for hematopoietic cell transplant (HCT) recipients. Non-invasive biomarkers, such as the beta-D-glucan assay, may improve the diagnosis of IFD. The objective was to define the utility of surveillance testing using Fungitell® beta-D-glucan (BDG) assay in children receiving antifungal prophylaxis in the immediate post-HCT period. METHODS Weekly surveillance blood testing with the Fungitell® BDG assay was performed during the early post-HCT period in the context of a randomized trial of children, adolescents, and young adults undergoing allogeneic HCT allocated to triazole or caspofungin prophylaxis. Positivity was defined at the manufacturer cutoff of 80 pg/ml. IFD was adjudicated using blinded central reviewers. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for the Fungitell® BDG assay for the outcome of proven or probable IFD. RESULTS A total of 51 patients (out of 290 patients in the parent trial) contributed blood specimens. In total, 278 specimens were evaluated. Specificity was 80.8% (95% confidence interval [CI]: 75.6%-85.3%), and NPV was over 99% (95% CI: 86.8%-99.9%). However, there were no true positive results, resulting in sensitivity of 0% (95% CI: 0.0%-84.2%) and PPV of 0% (95% CI: 0.0%-6.7%). CONCLUSIONS Fungitell® BDG screening is of limited utility in diagnosing IFD in the post-HCT period, mainly due to high false-positive rates. Fungitell® BDG surveillance testing should not be performed in children during the early post-HCT period while receiving antifungal prophylaxis as the pretest probability for IFD is low.
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Affiliation(s)
- William R. Otto
- Division of Pediatrics Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Christopher C. Dvorak
- Division of Pediatric Allergy, Immunology and Bone Marrow Transplant, University of California San Francisco, San Francisco, CA
| | - Craig L. K. Boge
- Division of Pediatrics Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Luis Ostrosky-Zeichner
- Division of Infectious Diseases, University of Texas-Houston McGovern Medical School, Houston, TX
| | - Adam J. Esbenshade
- Division of Pediatric Hematology and Oncology, Vanderbilt University Medical Center, Nashville, TN
| | - Michael L. Nieder
- Division of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, FL
| | - Sarah Alexander
- Division of Haematology Oncology, The Hospital for Sick Children, Toronto, Ontario
| | - William J. Steinbach
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Ha Dang
- Biostatistics and Data Management, Johnson and Johnson Medical Devices Companies, Irvine, CA
| | | | - Lu Chen
- Division of Biostatistics, City of Hope, Duarte, CA
| | - Micah Skeens
- Department of Hematology/Oncology, Nationwide Children’s Hospital, Columbus, Ohio, USA
| | | | - Lillian Sung
- Division of Haematology Oncology, The Hospital for Sick Children, Toronto, Ontario
| | - Brian T. Fisher
- Division of Pediatrics Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, PA
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16
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Long-Term Kinetics of Serum Galactomannan during Treatment of Complicated Invasive Pulmonary Aspergillosis. J Fungi (Basel) 2023; 9:jof9020157. [PMID: 36836274 PMCID: PMC9965572 DOI: 10.3390/jof9020157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 01/19/2023] [Accepted: 01/19/2023] [Indexed: 01/26/2023] Open
Abstract
Several studies have evaluated the serum galactomannan (GM) antigen assay in pediatric patients, and there is convincing evidence for its usefulness as a diagnostic tool for invasive Aspergillus infections in patients with acute leukemias or post allogeneic hematopoietic cell transplantation (HCT). Less is known about the utility of the assay in monitoring responses to treatment in patients with established invasive aspergillosis (IA). Here, we present the long-term kinetics of serum galactomannan in two severely immunocompromised adolescents with invasive pulmonary aspergillosis (IPA) who were cured after complicated clinical courses. We also review the utility of the GM antigen assay in serum as a prognostic tool around the time of diagnosis of IA and as a biomarker to monitor disease activity in patients with established IA and assess responses to systemic antifungal therapy.
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17
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Serum Beta-D-Glucan in the Diagnosis of Invasive Fungal Disease in Neonates, Children and Adolescents: A Critical Analysis of Current Data. J Fungi (Basel) 2022; 8:jof8121262. [PMID: 36547595 PMCID: PMC9783846 DOI: 10.3390/jof8121262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 11/27/2022] [Accepted: 11/29/2022] [Indexed: 12/02/2022] Open
Abstract
β-D-glucan (BDG) is a cell wall component of many pathogenic fungi. The detection of BDG as an assay is clinically broadly used as a diagnostic tool. However, the current data on BDG in paediatrics are limited, prompting specific considerations about when BDG can be used in neonates and children. We aimed to analyse the available data for the use of serum BDG in neonates and immunocompromised children and adolescents; as well as to understand the extent and characteristics of the use of BDG in children in Europe.
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18
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Kanj SS, Omrani AS, Al-Abdely HM, Subhi A, Fakih RE, Abosoudah I, Kanj H, Dimopoulos G. Survival Outcome of Empirical Antifungal Therapy and the Value of Early Initiation: A Review of the Last Decade. J Fungi (Basel) 2022; 8:1146. [PMID: 36354913 PMCID: PMC9695378 DOI: 10.3390/jof8111146] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 10/17/2022] [Accepted: 10/19/2022] [Indexed: 10/03/2023] Open
Abstract
AIM This rapid systematic review aimed to collect the evidence published over the last decade on the effect of empirical antifungal therapy and its early initiation on survival rates. METHODS A systematic search was conducted in PubMed, Cochrane, Medline, Scopus, and Embase, in addition to a hand search and experts' suggestions. RESULTS Fourteen cohort studies and two randomized clinical trials reporting the survival outcome of empirical antifungal therapy were included in this review. Two studies reported the association between early empirical antifungal therapy (EAFT) and survival rates in a hematological cancer setting, and fourteen studies reported the outcome in patients in intensive care units (ICU). Six studies reported that appropriate EAFT decreases hospital mortality significantly; ten studies could not demonstrate a statistically significant association with mortality rates. DISCUSSION The inconsistency of the results in the literature can be attributed to the studies' small sample size and their heterogeneity. Many patients who may potentially benefit from such strategies were excluded from these studies. CONCLUSION While EAFT is practiced in many settings, current evidence is conflicting, and high-quality studies are needed to demonstrate the true value of this approach. Meanwhile, insights from experts in the field can help guide clinicians to initiate EAFT when indicated.
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Affiliation(s)
- Souha S. Kanj
- Division of Infectious Diseases, Department of Internal Medicine, American University of Beirut Medical Center, Riad El Solh, Beirut P.O. Box 11-0236, Lebanon
| | - Ali S. Omrani
- Division of Infectious Diseases, Department of Medicine, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar
- College of Medicine, Qatar University, Doha P.O. Box 2713, Qatar
| | - Hail M. Al-Abdely
- Division of Infectious Diseases, Department of Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia
| | - Ahmad Subhi
- Division of Infectious Disease, Al-Qassimi Hospital, Emirates Health Services, Sharjah 61313, United Arab Emirates
| | - Riad El Fakih
- Department of Hematology, Stem Cell Transplant & Cellular Therapy, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia
| | - Ibraheem Abosoudah
- Department of Oncology, King Faisal Specialist Hospital and Research Center, MBC J-64, Jeddah 21499, Saudi Arabia
| | - Hazar Kanj
- Faculty of Medicine, American University of Beirut Medical Center, Beirut P.O. Box 11-0236, Lebanon
| | - George Dimopoulos
- Department of Critical Care, “EVGENIDIO” Hospital, National and Kapodistrian University of Athens (NKUA), 10679 Athens, Greece
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Novel Insights into Fungal Infections Prophylaxis and Treatment in Pediatric Patients with Cancer. Antibiotics (Basel) 2022; 11:antibiotics11101316. [PMID: 36289974 PMCID: PMC9598217 DOI: 10.3390/antibiotics11101316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/20/2022] [Accepted: 09/22/2022] [Indexed: 11/23/2022] Open
Abstract
Invasive fungal diseases (IFDs) are a relevant cause of morbidity and mortality in children with cancer. Their correct prevention and management impact patients’ outcomes. The aim of this review is to highlight the rationale and novel insights into antifungal prophylaxis and treatment in pediatric patients with oncological and hematological diseases. The literature analysis showed that IFDs represent a minority of cases in comparison to bacterial and viral infections, but their impact might be far more serious, especially when prolonged antifungal therapy or invasive surgical treatments are required to eradicate colonization. A personalized approach is recommended since pediatric patients with cancer often present with different complications and require tailored therapy. Moreover, while the Aspergillus infection rate does not seem to increase, in the near future, new therapeutic recommendations should be required in light of new epidemiological data on Candidemia due to resistant species. Finally, further studies on CAR-T treatment and other immunotherapies are needed in patients with unique needs and the risk of complications. Definitive guidelines on IFD treatment considering the evolving epidemiology of antifungal resistance, new therapeutic approaches in pediatric cancer, novel antifungal drugs and the importance of an appropriate antifungal stewardship are urgently needed.
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20
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Infections fongiques invasives chez l’enfant immunodéprimé en hématologie pédiatrique : recommandations de prise en charge au sein des centres de la SFCE. Bull Cancer 2022; 109:1109-1124. [DOI: 10.1016/j.bulcan.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 08/08/2022] [Accepted: 08/17/2022] [Indexed: 11/23/2022]
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Liu Y, Zhang X, Yue T, Tang Y, Ke Z, Li Y, Luo X, Huang L. Combination of C-Reactive Protein and Procalcitonin in Distinguishing Fungal from Bacterial Infections Early in Immunocompromised Children. Antibiotics (Basel) 2022; 11:antibiotics11060730. [PMID: 35740137 PMCID: PMC9219757 DOI: 10.3390/antibiotics11060730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/23/2022] [Accepted: 05/27/2022] [Indexed: 11/16/2022] Open
Abstract
Invasive fungal infection (IFI) is life-threatening in children with cancer and hematology disorders, especially when diagnosis and treatment are delayed. Conventional β-D-glucan and galactomannan tests have poor positive predictive values in the diagnosis of IFI in children with cancer. This study aims to access the diagnostic performance of C-reactive protein (CRP) and procalcitonin (PCT) in differentiating IFI from bacterial bloodstream infections in children with malignant and hematology disorders. CRP and PCT levels were measured in samples taken from patients between 12 and 24 h after fever onset, of which 24 and 102 were in the IFI and bacterial groups, respectively. We found that the CRP levels were much higher in the IFI group than the bacterial group (100.57 versus 40.04 mg/L, median, p < 0.001), while the PCT levels remained significantly lower (0.45 versus 1.29 μg/L, median, p = 0.007). Both CRP and PCT showed significant diagnostic utilities with an area under the curve (AUC) of 0.780 (95% CI, 0.664−0.896, p < 0.001) and 0.731 (95% CI, 0.634−0.828, p < 0.001) when using the cut-off values of 94.93 mg/L and 2.00 μg/L, respectively. However, the combined biomarker of CRP and PCT yielded a better diagnostic performance with an AUC of 0.934 (95% confidential interval (CI), 0.881−0.987, p < 0.001), which was significantly higher than that of CRP or PCT (both p < 0.001), with a sensitivity of 87.5% and a specificity of 87.3%. Our study demonstrates high levels of CRP combined with low PCT could differentiate IFI from bacterial bloodstream infections in immunocompromised children.
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Affiliation(s)
| | | | | | | | | | | | - Xuequn Luo
- Correspondence: (X.L.); (L.H.); Tel.: +86-20-87338822 (L.H.); Fax: +86-20-87755766 (L.H.)
| | - Libin Huang
- Correspondence: (X.L.); (L.H.); Tel.: +86-20-87338822 (L.H.); Fax: +86-20-87755766 (L.H.)
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Pediatric Invasive Fungal Risk Score in Cancer and Hematopoietic Stem Cell Transplantation Patients With Febrile Neutropenia. J Pediatr Hematol Oncol 2022; 44:e334-e342. [PMID: 34224520 DOI: 10.1097/mph.0000000000002242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 05/21/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Invasive fungal diseases (IFDs) are opportunistic infections that result in significant morbidity and mortality in pediatric oncology patients. Predictive risk tools for IFD in pediatric cancer are not available. METHODS We conducted a 7-year retrospective study of pediatric oncology patients with a diagnosis of febrile neutropenia at UCM Comer Children's Hospitals. Fourteen clinical, laboratory, and treatment-related risk factors for IFD were analyzed. Stepwise variable selection for multiple logistic regression was used to develop a risk prediction model for IFD. Two comparative analyses have been conducted: (i) all suspected IFD cases and (ii) all proven and probable IFD cases. RESULTS A total of 667 febrile neutropenia episodes were identified in 265 patients. IFD was diagnosed in 62 episodes: 13 proven, 27 probable, and 22 possible. In the final multiple logistic regression models, 5 variables were independently significant for both analyses: fever days, neutropenia days, hypotension, and absolute lymphocyte count <250 at the time of diagnosis. The odds ratio and a relative weight for each factor were then calculated and summed to calculate a predictive score. A risk score of ≤4 and ≤5 (10/11 maximum) for each model signifies low risk, respectively (<1.2% incidence). Model discrimination was evaluated by the area under the receiver operator characteristics curve with an area under the curve of 0.95/0.94 for each model. CONCLUSION Our prediction IFD risk models perform well, are easy-to-use, and are based on readily available clinical data. Profound lymphopenia absolute lymphocyte count <250 mm3 could serve as a new important prognostic marker for the development of IFD in pediatric cancer and hematopoietic stem cell transplant patients.
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Douglas AP, Smibert OC, Bajel A, Halliday CL, Lavee O, McMullan B, Yong MK, Hal SJ, Chen SC. Consensus guidelines for the diagnosis and management of invasive aspergillosis, 2021. Intern Med J 2021; 51 Suppl 7:143-176. [DOI: 10.1111/imj.15591] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Abby P. Douglas
- Department of Infectious Diseases Peter MacCallum Cancer Centre Melbourne Victoria Australia
- Sir Peter MacCallum Department of Oncology University of Melbourne Melbourne Victoria Australia
- National Centre for Infections in Cancer Peter MacCallum Cancer Centre Melbourne Victoria Australia
- Department of Infectious Diseases Austin Health Melbourne Victoria Australia
| | - Olivia. C. Smibert
- Department of Infectious Diseases Peter MacCallum Cancer Centre Melbourne Victoria Australia
- Sir Peter MacCallum Department of Oncology University of Melbourne Melbourne Victoria Australia
- National Centre for Infections in Cancer Peter MacCallum Cancer Centre Melbourne Victoria Australia
- Department of Infectious Diseases Austin Health Melbourne Victoria Australia
| | - Ashish Bajel
- Sir Peter MacCallum Department of Oncology University of Melbourne Melbourne Victoria Australia
- Department of Clinical Haematology Peter MacCallum Cancer Centre and The Royal Melbourne Hospital Melbourne Victoria Australia
| | - Catriona L. Halliday
- Centre for Infectious Diseases and Microbiology Laboratory Services Institute of Clinical Pathology and Medical Research, New South Wales Health Pathology, Westmead Hospital Sydney New South Wales Australia
- Marie Bashir Institute for Infectious Diseases and Biosecurity The University of Sydney Sydney New South Wales Australia
| | - Orly Lavee
- Department of Haematology St Vincent's Hospital Sydney New South Wales Australia
| | - Brendan McMullan
- National Centre for Infections in Cancer Peter MacCallum Cancer Centre Melbourne Victoria Australia
- Department of Immunology and Infectious Diseases Sydney Children's Hospital Sydney New South Wales Australia
- School of Women's and Children's Health University of New South Wales Sydney New South Wales Australia
| | - Michelle K. Yong
- Department of Infectious Diseases Peter MacCallum Cancer Centre Melbourne Victoria Australia
- Sir Peter MacCallum Department of Oncology University of Melbourne Melbourne Victoria Australia
- National Centre for Infections in Cancer Peter MacCallum Cancer Centre Melbourne Victoria Australia
- Victorian Infectious Diseases Service Royal Melbourne Hospital Melbourne Victoria Australia
| | - Sebastiaan J. Hal
- Sydney Medical School University of Sydney Sydney New South Wales Australia
- Department of Microbiology and Infectious Diseases Royal Prince Alfred Hospital Sydney New South Wales Australia
| | - Sharon C.‐A. Chen
- Centre for Infectious Diseases and Microbiology Laboratory Services Institute of Clinical Pathology and Medical Research, New South Wales Health Pathology, Westmead Hospital Sydney New South Wales Australia
- Marie Bashir Institute for Infectious Diseases and Biosecurity The University of Sydney Sydney New South Wales Australia
- Sydney Medical School University of Sydney Sydney New South Wales Australia
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Fisher BT. Fungal diagnostic testing and therapy: navigating the neutropenic period in children with high-risk leukemia. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2021; 2021:361-367. [PMID: 34889439 PMCID: PMC8791115 DOI: 10.1182/hematology.2021000267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Children, adolescents, and young adults receiving intensive chemotherapy for acute myeloid leukemia or high-risk or relapsed acute lymphoblastic leukemia sustain prolonged periods of neutropenia that predispose them to invasive fungal disease (IFD). For many decades the standard of care for these patients was to initiate empirical antifungal therapy after a period of prolonged fever and neutropenia. Recent publications have yielded important evidence on the utility of different diagnostic and therapeutic approaches aimed at reducing the impact of IFD among these patients during these vulnerable periods. This case-based review highlights and interprets the published data to provide context for the IFD diagnostic and therapeutic recommendations proposed in multiple published guidelines. Personalized approaches are offered at points where evidence is lacking. Time points where specific knowledge gaps exist are identified along the clinical trajectory of the prolonged neutropenic period to illustrate areas for future investigation.
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Affiliation(s)
- Brian T. Fisher
- Correspondence Brian T. Fisher, Division of Infectious Diseases, Children's Hospital of Philadelphia, Roberts Pediatric Research Center, 2716 South Str, Rm 10-362, Philadelphia, PA 19146; e-mail:
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Mikulska M, Balletto E, Castagnola E, Mularoni A. Beta-D-Glucan in Patients with Haematological Malignancies. J Fungi (Basel) 2021; 7:jof7121046. [PMID: 34947028 PMCID: PMC8706797 DOI: 10.3390/jof7121046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 12/01/2021] [Accepted: 12/02/2021] [Indexed: 12/12/2022] Open
Abstract
(1-3)-beta-D-glucan (BDG) is an almost panfungal marker (absent in zygomycetes and most cryptococci), which can be successfully used in screening and diagnostic testing in patients with haematological malignancies if its advantages and limitations are known. The aim of this review is to report the data, particularly from the last 5 years, on the use of BDG in haematological population. Published data report mainly on the performance of the Fungitell™ assay, although several others are currently available, and they vary in method and cut-off of positivity. The sensitivity of BDG for invasive fungal disease (IFD) in haematology patients seems lower than in other populations, possibly because of the type of IFD (lower sensitivity was found in case of aspergillosis compared to candidiasis and pneumocystosis) or the use of prophylaxis. The specificity of the test can be improved by using two consecutive positive assays and avoiding testing in the case of the concomitant presence of factors associated with false positive results. BDG should be used in combination with clinical assessment and other diagnostic tests, both radiological and mycological, to provide maximum information. Good performance of BDG in cerebrospinal fluid (CSF) has been reported. BDG is a useful diagnostic method in haematology patients, particularly for pneumocystosis or initial diagnosis of invasive fungal infections.
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Affiliation(s)
- Malgorzata Mikulska
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genoa, 16132 Genoa, Italy
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy;
- Correspondence: ; Tel.: +39-010-555-4649
| | - Elisa Balletto
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy;
| | - Elio Castagnola
- Infectious Diseases Unit, Department of Pediatrics, Istituto Giannina Gaslini, 16147 Genova, Italy;
| | - Alessandra Mularoni
- IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), 90127 Palermo, Italy;
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Özen S, Özdemir H, Evren E, Taşkın EÇ, Arga G, Konca HK, Çakmaklı HF, Haskoloğlu Ş, Okulu E, Dinçaslan H, İnce E, İleri T, Taçyıldız N, Doğu F, Us E, Karahan ZC, Fitöz S, Kendirli T, Kuloğlu Z, Tutar E, İkincioğulları A, Ünal E, Ertem M, İnce E, Çiftçi E. The role of galactomannan test results in the diagnosis of pediatric invasive aspergillosis. Infect Dis (Lond) 2021; 54:269-276. [PMID: 34842498 DOI: 10.1080/23744235.2021.2008486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Invasive aspergillosis (IA) is an important cause of morbidity and mortality in immunosuppressed children. Early detection of the infection can improve prognosis in this patient population. OBJECTIVES To investigate the utility of Aspergillus galactomannan antigen assay (GM-EIA) as a diagnostic tool for IA in at-risk paediatric patients. PATIENTS/METHODS For the study, 659 GM-EIA results from 59 patients diagnosed with IA and 3368 GM-EIA results from 351 subjects without evidence for IA (controls) were reviewed retrospectively. Three cut-off values (i.e. ≥0.5, ≥1, ≥1.5) were specified to determine GM-EIA positivity. RESULTS The median age was 6.3 years for boys and 14.5 years for girls. There was a significant difference between the girls and boys in terms of age (p < 0.01). For proven/probable/possible IA patients, sensitivity of 67.8% and specificity of 59.8% were detected when the ≥0.5 cut-off value was used for GM-EIA-positivity. The specificity increased to 80% at the cut-off of ≥1 and to 88% at the cut-off of ≥1.5. False positivity rates were 9.14, 3, and 1.45% at the ≥0.5, ≥1 and ≥1.5 cut-offs respectively. In the proven/probable IA group, sensitivity and negative predictive values were 86.9 and 97.2% at the ≥0.5 cut-off, 85.7 and 97.9%, at the ≥1 cut-off and 84.2 and 98.1% at ≥1.5 cut-off respectively. The positive likelihood ratio was 7.57 and the odds ratio was 42.67 at ≥1.5 cut-off. CONCLUSION The GM-EIA may be used for both screening and diagnostic purposes in paediatric patients using a cut-off value of ≥1.5 for GM-EIA positivity.
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Affiliation(s)
- Seval Özen
- Division of Pediatric Infectious Diseases, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Halil Özdemir
- Division of Pediatric Infectious Diseases, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Ebru Evren
- Department of Medical Microbiology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Esra Çakmak Taşkın
- Division of Pediatric Infectious Diseases, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Gül Arga
- Division of Pediatric Infectious Diseases, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Hatice Kübra Konca
- Division of Pediatric Infectious Diseases, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Hasan Fatih Çakmaklı
- Division of Pediatric Hematology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Şule Haskoloğlu
- Division of Pediatric Immunology and Allergy, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Emel Okulu
- Division of Neonatology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Handan Dinçaslan
- Division of Pediatric Oncology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Elif İnce
- Division of Pediatric Hematology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Talia İleri
- Division of Pediatric Hematology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Nurdan Taçyıldız
- Division of Pediatric Oncology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Figen Doğu
- Division of Pediatric Immunology and Allergy, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Ebru Us
- Department of Medical Microbiology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Zeynep Ceren Karahan
- Department of Medical Microbiology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Suat Fitöz
- Department of Radiology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Tanıl Kendirli
- Division of Pediatric Intensive Care, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Zarife Kuloğlu
- Division of Pediatric Gastroenterology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Ercan Tutar
- Division of Pediatric Cardiology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Aydan İkincioğulları
- Division of Pediatric Immunology and Allergy, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Emel Ünal
- Division of Pediatric Oncology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Mehmet Ertem
- Division of Pediatric Hematology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Erdal İnce
- Division of Pediatric Infectious Diseases, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Ergin Çiftçi
- Division of Pediatric Infectious Diseases, Ankara University Faculty of Medicine, Ankara, Turkey
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Fisher BT, Westling T, Boge CLK, Zaoutis TE, Dvorak CC, Nieder M, Zerr DM, Wingard JR, Villaluna D, Esbenshade AJ, Alexander S, Gunn S, Wheat LJ, Sung L. Prospective Evaluation of Galactomannan and (1→3) β-d-Glucan Assays as Diagnostic Tools for Invasive Fungal Disease in Children, Adolescents, and Young Adults With Acute Myeloid Leukemia Receiving Fungal Prophylaxis. J Pediatric Infect Dis Soc 2021; 10:864-871. [PMID: 34173659 PMCID: PMC8527733 DOI: 10.1093/jpids/piab036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 04/30/2021] [Indexed: 11/13/2022]
Abstract
BACKGROUND Patients receiving chemotherapy for acute myeloid leukemia (AML) are at high risk for invasive fungal disease (IFD). Diagnosis of IFD is challenging, leading to interest in fungal biomarkers. The objective was to define the utility of surveillance testing with Platelia Aspergillus galactomannan (GM) enzyme immunoassay (EIA) and Fungitell β-d-glucan (BDG) assay in children with AML receiving antifungal prophylaxis. METHODS Twice-weekly surveillance blood testing with GM EIA and BDG assay was performed during periods of neutropenia in the context of a randomized trial of children, adolescents, and young adults with AML allocated to fluconazole or caspofungin prophylaxis. Proven or probable IFD was adjudicated using blinded central reviewers. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for Platelia and Fungitell assays alone and in combination for the outcomes of proven and probable invasive aspergillosis (IA) or invasive candidiasis (IC). RESULTS Among 471 patients enrolled, 425 participants (209 fluconazole and 216 caspofungin) contributed ≥1 blood specimen. In total, 6103 specimens were evaluated, with a median of 15 specimens per patient (range 1-43). The NPV was >99% for GM EIA and BDG assay alone and in combination. However, there were no true positive results, resulting in sensitivity and PPV for each assay of 0%. CONCLUSIONS The GM EIA and the BDG assay alone or in combination were not successful at detecting IA or IC during periods of neutropenia in children, adolescents, and young adults with AML receiving antifungal prophylaxis. Utilization of these assays for surveillance in this clinical setting should be discouraged.
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Affiliation(s)
- Brian T Fisher
- Division of Infectious Diseases, Children’s Hospital
of Philadelphia, Philadelphia,
Pennsylvania, USA
| | - Ted Westling
- Department of Mathematics and Statistics, University of
Massachusetts Amherst, Amherst,
Massachusetts, USA
| | - Craig L K Boge
- Division of Infectious Diseases, Children’s Hospital
of Philadelphia, Philadelphia,
Pennsylvania, USA
| | - Theoklis E Zaoutis
- Division of Infectious Diseases, Children’s Hospital
of Philadelphia, Philadelphia,
Pennsylvania, USA
| | - Christopher C Dvorak
- Division of Pediatric Allergy, Immunology and Bone Marrow
Transplant, University of California San Francisco, San
Francisco, California, USA
| | - Michael Nieder
- Division of Blood and Marrow Transplant and Cellular
Immunotherapy, Moffitt Cancer Center, Tampa,
Florida, USA
| | - Danielle M Zerr
- Division of Pediatric Infectious Diseases, Seattle
Children’s Hospital, Seattle,
Washington, USA
| | - John R Wingard
- University of Florida College of Medicine,
Gainesville, Florida, USA
| | | | - Adam J Esbenshade
- Division of Pediatric Hematology and Oncology, Vanderbilt
University Medical Center, Nashville,
Tennessee, USA
| | - Sarah Alexander
- Division of Haematology Oncology, The Hospital for Sick
Children, Toronto, Ontario, Canada
| | - Suphansa Gunn
- Miravista Diagnostics, LLC,
Indianapolis, Indiana, USA
| | | | - Lillian Sung
- Division of Haematology Oncology, The Hospital for Sick
Children, Toronto, Ontario, Canada
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Olivier-Gougenheim L, Rama N, Dupont D, Saultier P, Leverger G, AbouChahla W, Paillard C, Gandemer V, Theron A, Freycon C, Pluchart C, Blouin P, Pellier I, Thouvenin-Doulet S, Desplantes C, Ducassou S, Oudot C, Rouger-Gaudichon J, Cheikh N, Poiree M, Schneider P, Plat G, Contet A, Rialland F, Gouache E, Brethon B, Bertrand Y, Domenech C. Invasive Fungal Infections in Immunocompromised Children: Novel Insight Following a National Study. J Pediatr 2021; 236:204-210. [PMID: 33991540 DOI: 10.1016/j.jpeds.2021.05.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 04/28/2021] [Accepted: 05/07/2021] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To obtain a national overview of the epidemiology and management of invasive fungal infections (IFIs) in France for severely immunocompromised children who were treated for acute leukemia or had undergone allogeneic hematopoietic stem cell transplantation (a-HSCT). STUDY DESIGN We performed a national multicenter retrospective study to collect epidemiologic data for proven and probable IFIs in children with acute leukemia under first- line or relapse treatment or who had undergone a-HSCT. We also conducted a prospective practice survey to provide a national overview of IFI management in pediatric hematology units. RESULTS From January 2014 to December 2017, 144 cases of IFI were diagnosed (5.3%) in 2721 patients, including 61 cases of candidiasis, 60 cases of aspergillosis, and 23 cases of infection with "emergent" fungi, including 10 cases of mucormycosis and 6 cases of fusariosis. The IFI rate was higher in patients with acute myelogenous leukemia (12.9%) (OR, 3.24; 95% CI, 2.15-4.81; P < .0001) compared with the rest of the cohort. Patients undergoing a-HSCT had an IFI rate of only 4.3%. In these patients, the use of primary antifungal prophylaxis (principally fluconazole) was associated with a lower IFI rate (OR, 0.28; 95% CI, 0.14-0.60; P = 4.90 ×10-4) compared with a-HSCT recipients who did not receive antifungal prophylaxis. The main cause of IFI in children receiving prophylaxis was emergent pathogens (41%), such as mucormycosis and fusariosis, which were resistant to the prophylactic agents. CONCLUSIONS The emerging fungi and new antifungal resistance profiles uncovered in this study should be considered in IFI management in immunocompromised children.
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Affiliation(s)
- Laura Olivier-Gougenheim
- Institute of Pediatric Hematology and Oncology, Hospices Civils de Lyon, University Lyon 1, Lyon, France.
| | - Nicolas Rama
- Apoptosis, Cancer and Development Laboratory, INSERM U1052, CNRS UMR5286, CRCL, Lyon, France
| | - Damien Dupont
- Institut des Agents Infectieux, Parasitology-Mycology Unit, Lyon, France
| | - Paul Saultier
- Pediatric Hematology-OncologyUnit, CHU Marseille, Marseille, France
| | - Guy Leverger
- Pediatric Hematology-Oncology Unit, AP-HP Trousseau, Paris, France
| | | | | | | | - Alexandre Theron
- Pediatric Hematology-Oncology Unit, CHU Montpellier, Montpellier, France
| | - Claire Freycon
- Pediatric Hematology-Oncology Unit, CHU Grenoble, Grenoble, France
| | - Claire Pluchart
- Pediatric Hematology-Oncology Unit, Institut Jean Godinot, CHU Reims, Reims, France
| | - Pascale Blouin
- Pediatric Hematology-Oncology Unit, CHU Tours, Tours, France
| | | | | | | | | | - Caroline Oudot
- Pediatric Hematology-Oncology Unit, CHU Limoges, Limoges, France
| | | | - Nathalie Cheikh
- Pediatric Hematology-Oncology Unit, CHU Besançon, Besançon, France
| | - Maryline Poiree
- Pediatric Hematology-Oncology Unit, CHU Lenval Nice, Nice, France
| | | | - Genevieve Plat
- Pediatric Hematology-Oncology Unit, CHU Toulouse, Toulouse, France
| | - Audrey Contet
- Pediatric Hematology-Oncology Unit, CHU Nancy, Nancy, France
| | - Fanny Rialland
- Pediatric Hematology-Oncology Unit, CHU Nantes, Nantes, France
| | - Elodie Gouache
- Pediatric Hematology-Oncology Unit, AP-HP Trousseau, Paris, France
| | - Benoit Brethon
- Pediatric Hematology Unit, AP-HP Robert Debré, Paris, France
| | - Yves Bertrand
- Institute of Pediatric Hematology and Oncology, Hospices Civils de Lyon, University Lyon 1, Lyon, France
| | - Carine Domenech
- Institute of Pediatric Hematology and Oncology, Hospices Civils de Lyon, University Lyon 1, Lyon, France; Apoptosis, Cancer and Development Laboratory, INSERM U1052, CNRS UMR5286, CRCL, Lyon, France
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Singh S, Singh M, Verma N, Sharma M, Pradhan P, Chauhan A, Jaiswal N, Chakrabarti A, Singh M. Comparative accuracy of 1,3 beta-D glucan and galactomannan for diagnosis of invasive fungal infections in pediatric patients: a systematic review with meta-analysis. Med Mycol 2021; 59:139-148. [PMID: 32448907 DOI: 10.1093/mmy/myaa038] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 03/16/2020] [Accepted: 05/01/2020] [Indexed: 12/26/2022] Open
Abstract
Invasive fungal infections (IFI) cause considerable morbidity and mortality in pediatric patients. Serum biomarkers such as 1,3-beta-D glucan (BDG) and galactomannan (GM) have been evaluated for the IFI diagnosis. However, most evidence regarding their utility is derived from studies in adult oncology patients. This systematic review aimed to compare the diagnostic accuracy of BDG and GM individually or in combination for diagnosing IFI in pediatric patients. PubMed, CINAHL, Embase, and Cochrane Library were searched until March 2019 for diagnostic studies evaluating both serum GM and BDG for diagnosing pediatric IFI. The pooled diagnostic odds ratio (DOR), specificity and sensitivity were computed. Receiver operating characteristics (ROC) curve and area under the curve (AUC) were used for summarizing overall assay performance. Six studies were included in the meta-analysis. The summary estimates of sensitivity, specificity, pooled DOR, AUC of the GM assay for proven or probable IFI were 0.74, 0.76, 13.25, and 0.845. The summary estimates of sensitivity, specificity, pooled DOR, AUC of the BDG assay were 0.70, 0.69, 4.3, and 0.722. The combined predictive ability of both tests was reported in two studies (sensitivity: 0.67, specificity: 0.877). Four studies were performed in hematology-oncology patients, while two were retrospective studies from pediatric intensive care units (ICUs). In the subgroup of hematology-oncology patients, DOR of BDG remained similar at 4.25 but increased to 40.28 for GM. We conclude that GM and BDG have a modest performance for identifying IFI in pediatric patients. GM has a better accuracy over BDG. Combining both improves the specificity at the cost of sensitivity.
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Affiliation(s)
- Shreya Singh
- Department of Medical Microbiology, Postgraduate institute of medical education and research (PGIMER), Chandigarh, 160012
| | - Manvi Singh
- Department of Pediatrics, Postgraduate institute of medical education and research (PGIMER), Chandigarh, 160012
| | - Nipun Verma
- Department of Hepatology, Postgraduate institute of medical education and research (PGIMER), Chandigarh, 160012
| | - Minakshi Sharma
- Department of Pediatrics, Postgraduate institute of medical education and research (PGIMER), Chandigarh, 160012
| | - Pranita Pradhan
- Department of Pediatrics, Postgraduate institute of medical education and research (PGIMER), Chandigarh, 160012
| | - Anil Chauhan
- Department of Pediatrics, Postgraduate institute of medical education and research (PGIMER), Chandigarh, 160012
| | - Nishant Jaiswal
- Department of Pediatrics, Postgraduate institute of medical education and research (PGIMER), Chandigarh, 160012
| | - Arunaloke Chakrabarti
- Department of Medical Microbiology, Postgraduate institute of medical education and research (PGIMER), Chandigarh, 160012
| | - Meenu Singh
- Department of Medical Microbiology, Postgraduate institute of medical education and research (PGIMER), Chandigarh, 160012
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Challenges with Utilizing the 1,3-Beta-d-Glucan and Galactomannan Assays To Diagnose Invasive Mold Infections in Immunocompromised Children. J Clin Microbiol 2021; 59:e0327620. [PMID: 33883182 DOI: 10.1128/jcm.03276-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
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.
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31
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Melgar M, Reljic T, Barahona G, Camacho K, Chang A, Contreras J, Espinoza D, Estripeaut D, Gamero M, Luque M, Mentor G, Zacasa P, Homsi M, Caniza MA, Kumar A, Mukkada S. Guidance Statement for the Management of Febrile Neutropenia in Pediatric Patients Receiving Cancer-Directed Therapy in Central America and the Caribbean. JCO Glob Oncol 2021; 6:508-517. [PMID: 32216650 PMCID: PMC7124939 DOI: 10.1200/jgo.19.00329] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
PURPOSE Our objective was to provide regionally appropriate, resource-conscious recommendations for the diagnosis and treatment of pediatric patients with febrile neutropenia. METHODS A multinational panel of Central American and Caribbean clinicians who deliver pediatric oncology care prioritized clinically important questions and then used the Grading of Recommendations Assessment, Development and Evaluation methodology to provide recommendations on the selected topics. RESULTS Twenty-two questions and 2 definitions were included in the guideline, which was intended to establish minimum care standards for pediatric patients treated in regional centers. Of all the included studies, 6.9% were conducted in low- and middle-income countries, and no studies were performed in countries represented on the panel. CONCLUSION The panel made recommendations on the basis of existing evidence but identified important gaps in knowledge from the region and from resource-limited settings that may affect the clinical applicability of these recommendations. These deficiencies suggest a research agenda that will enable future guidelines to be more responsive to the local context.
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Affiliation(s)
- Mario Melgar
- Unidad Nacional de Oncología Pediátrica, Guatemala City, Guatemala
| | - Tea Reljic
- Department of Internal Medicine, University of South Florida, Tampa, FL
| | | | - Kattia Camacho
- Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, San José, Costa Rica
| | - Alicia Chang
- Unidad Nacional de Oncología Pediátrica, Guatemala City, Guatemala
| | - Johanny Contreras
- Hospital Infantil Dr Robert Reid Cabral, Santo Domingo, Dominican Republic
| | - Darrell Espinoza
- Hospital Infantil Manuel de Jesus Rivera "La Mascota," Managua, Nicaragua
| | | | - Mario Gamero
- Hospital Nacional de Niños Benjamín Bloom, San Salvador, El Salvador
| | - Marco Luque
- Hospital Escuela Universitario, Tegucigalpa, Honduras
| | | | - Pamela Zacasa
- Hospital Escuela Universitario, Tegucigalpa, Honduras
| | - Maysam Homsi
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN
| | - Miguela A Caniza
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN.,Department of Infectious Diseases, St Jude Children's Research Hospital, Memphis, TN
| | - Ambuj Kumar
- Department of Internal Medicine, University of South Florida, Tampa, FL
| | - Sheena Mukkada
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN.,Department of Infectious Diseases, St Jude Children's Research Hospital, Memphis, TN
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Antifungal Combination Therapy in Children with Cancer-A 4-Year Analysis of Real-Life Data of Two Major Pediatric Cancer Centers. J Fungi (Basel) 2021; 7:jof7080604. [PMID: 34436143 PMCID: PMC8396953 DOI: 10.3390/jof7080604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 07/22/2021] [Accepted: 07/23/2021] [Indexed: 11/17/2022] Open
Abstract
Clinical data on antifungal combination therapy are limited, in particular in the pediatric setting. We analyzed real-life data collected in two major pediatric cancer centers over a period of 4 years. Patients were identified in an observational study on children with acute leukemia and lymphoma or undergoing hematopoietic cell transplantation. Out of 438 patients, 19 patients received 21 episodes of antifungal combination therapy. Therapy was mostly started for sepsis (n = 5) or clinical deterioration with pulmonary infiltrates (n = 10), and less often for periorbital swelling with suspected mold infection (n = 2), clinical deterioration and new skin lesions, secondary antifungal prophylaxis, a persistently elevated galactomannan index, or as pre-emptive treatment (n = 1 each). Diagnostics revealed proven, probable, and possible invasive fungal disease in two, seven and four episodes, respectively. Most regimens included caspofungin (n = 19), and treatment was initiated as first line therapy in 10 episodes. The median duration was 13 days (4-46 days). Nine of the 13 patients with proven, probable, or possible invasive fungal disease survived, which was comparable to patients receiving antifungal monotherapy. Our analysis demonstrates that combination therapy has mainly been prescribed in selected immunocompromised patients with clinical deterioration due to suspected invasive fungal disease or those with sepsis, and is well tolerated. Future studies need to better characterize clinical settings in which patients may benefit from antifungal combination therapy.
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Yan G, Chew KL, Chai LYA. Update on Non-Culture-Based Diagnostics for Invasive Fungal Disease. Mycopathologia 2021; 186:575-582. [PMID: 34213735 DOI: 10.1007/s11046-021-00549-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 03/19/2021] [Indexed: 02/06/2023]
Abstract
Diagnostic tests for fungi provide the mycological evidence to strengthen diagnosis of invasive fungal disease. Conventional microbiology and histopathology have their limitations. Recognizing this, there have been attempts at developing new methods to improve yield of diagnosing invasive fungal disease (IFD). The recent focus has been on non-culture-based antigen detection and molecular methods. The use of antigen detection of IFD through 1,3-β-D-glucan and galactomannan assay have been expanded, followed by development of lateral flow assays, and in combination with other diagnostic modalities to further increase diagnostic yield. The molecular diagnostic front has seen initiatives to standardize polymerase chain reaction methodologies to detect fungi and anti-fungal resistance, new platforms such as the T2Candida Biosystems and foray into fungal metagenomics. As these newer assays undergo stringent validation before incorporation into the diagnostic algorithm, the clinician needs to be mindful of their bedside utility as well as their limitation.
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Affiliation(s)
- Gabriel Yan
- Division of Microbiology, Department of Laboratory Medicine, National University Health System, Singapore, Singapore.,Division of Infectious Diseases, University Medicine Cluster, National University Health System, NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Ka Lip Chew
- Division of Microbiology, Department of Laboratory Medicine, National University Health System, Singapore, Singapore
| | - Louis Yi Ann Chai
- Division of Infectious Diseases, University Medicine Cluster, National University Health System, NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore. .,National University Cancer Institute, Singapore, Singapore. .,Department of Medicine, Faculty of Medicine, National University of Singapore, Singapore, Singapore.
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González-Vicent M, Ramos-Amador JT. [Fungal infection in immunocompromised children]. Rev Iberoam Micol 2021; 38:75-83. [PMID: 34148786 DOI: 10.1016/j.riam.2021.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/01/2021] [Accepted: 04/20/2021] [Indexed: 12/19/2022] Open
Abstract
In recent years, immunodeficiency condition has experienced a rise among children, who are at risk of invasive fungal infections (IFI) due to their health condition. Cancer, non-malignant hematological diseases, as primary immunodeficiencies, hematopoietic stem cell transplantation (HSCT), extreme prematurity, or critically ill condition in Pediatric Intensive Care Unit (PICU) are some immunosuppressive situations in children. The use of oncologic therapies, including immunotherapy and monoclonal antibodies, for the treatment of the aforementioned health conditions has led to an increase in morbidity and mortality rates of IFI in children. The underlying diseases and their management, comorbidities, the diagnostic tests used (both molecular and imaging), as well as the treatment used can be significantly different between adult patients and children admitted to PICU or with cancer. In pediatrics, the treatment of IFI is based primarily on pharmacokinetic studies performed in adults. In higher risk patients prophylaxis should be considered and, in the case of an IFI diagnosis, an antifungal treatment should be administered as early as possible, supported by the reversion of the immune dysfunction and surgery when appropriate.
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35
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Liu F, Zhang X, Du W, Du J, Chi Y, Sun B, Song Z, Shi J. Diagnosis values of IL-6 and IL-8 levels in serum and bronchoalveolar lavage fluid for invasive pulmonary aspergillosis in chronic obstructive pulmonary disease. J Investig Med 2021; 69:1344-1349. [PMID: 34127514 DOI: 10.1136/jim-2021-001857] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2021] [Indexed: 11/04/2022]
Abstract
Among immunologically normal hosts, patients with chronic obstructive pulmonary disease (COPD) are considered to be at high risk of invasive pulmonary aspergillosis (IPA), and early diagnosis and treatment are the key to improving the prognosis of patients. Here we aimed to evaluate whether interleukin (IL)-6 and IL-8 might be used in the detection and diagnosis of IPA in patients with COPD. We prospectively collected 106 patients with COPD and divided them into non-IPA (n=74), probable/possible IPA (n=26) and proven IPA (n=6). Platelia Aspergillus kit was used to detect galactomannan in bronchoalveolar lavage fluid (BALF), and serum and ELISA kit was used to detect IL-6 and IL-8 levels. Diagnostic efficiency of IL-6, IL-8 and galactomannan in serum and BALF was evaluated by receiver operating characteristic curve. Compared with the non-IPA group, the proven/probable IPA group showed significantly elevated levels of IL-6 and IL-8 in both serum and BALF, which were positively correlated with galactomannan levels. The sensitivity and specificity of IL-6 for diagnosing IPA were 74.32% and 81.25% (cut-off at 92.82 pg/mL, area under the curve (AUC)=0.8366) in serum and 68.92% and 71.88% (cut-off at 229.4 pg/mL, AUC=0.7694) in BALF. The sensitivity and specificity of IL-8 for diagnosing IPA were 83.78% and 81.25% (cut-off at 93.46 pg/mL, AUC=0.8756) in serum and 85.14% and 75.00% (cut-off at 325.4 pg/mL, AUC=0.8252) in BALF. The elevated levels of IL-6 and IL-8 in patients with IPA with COPD could be used as auxiliary indicators to diagnose IPA in addition to galactomannan.
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Affiliation(s)
- Fang Liu
- Department of Respiratory and Critical Care Medicine, Cangzhou Central Hospital, Cangzhou, Hebei, China
| | - Xin Zhang
- Department of Respiratory and Critical Care Medicine, Cangzhou Central Hospital, Cangzhou, Hebei, China
| | - Wenxiu Du
- Department of Respiratory and Critical Care Medicine, Cangzhou Central Hospital, Cangzhou, Hebei, China
| | - Junfeng Du
- Department of Respiratory and Critical Care Medicine, Cangzhou Central Hospital, Cangzhou, Hebei, China
| | - Yumin Chi
- Department of Respiratory and Critical Care Medicine, Cangzhou Central Hospital, Cangzhou, Hebei, China
| | - Baohua Sun
- Department of Respiratory and Critical Care Medicine, Cangzhou Central Hospital, Cangzhou, Hebei, China
| | - Zhan Song
- Department of Respiratory and Critical Care Medicine, Cangzhou Central Hospital, Cangzhou, Hebei, China
| | - Jian Shi
- Department of Respiratory and Critical Care Medicine, Cangzhou Central Hospital, Cangzhou, Hebei, China
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Mercier T, Castagnola E, Marr KA, Wheat LJ, Verweij PE, Maertens JA. Defining Galactomannan Positivity in the Updated EORTC/MSGERC Consensus Definitions of Invasive Fungal Diseases. Clin Infect Dis 2021; 72:S89-S94. [PMID: 33709125 DOI: 10.1093/cid/ciaa1786] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The consensus definitions of invasive fungal diseases from the EORTC/MSGERC were recently revised and updated. They now include consensus cutoff values for the galactomannan test that support the diagnosis of probable invasive aspergillosis. In this supplement article, we provide a rationale for these proposed thresholds based on the test's characteristics and performance in different patient populations and in different specimen types.
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Affiliation(s)
- Toine Mercier
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium.,Department of Hematology, University Hospitals Leuven, Leuven, Belgium
| | - Elio Castagnola
- Infectious Diseases Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Kieren A Marr
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Paul E Verweij
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Johan A Maertens
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium.,Department of Hematology, University Hospitals Leuven, Leuven, Belgium
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37
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White PL, Bretagne S, Caliendo AM, Loeffler J, Patterson TF, Slavin M, Wingard JR. Aspergillus Polymerase Chain Reaction-An Update on Technical Recommendations, Clinical Applications, and Justification for Inclusion in the Second Revision of the EORTC/MSGERC Definitions of Invasive Fungal Disease. Clin Infect Dis 2021; 72:S95-S101. [PMID: 33709129 DOI: 10.1093/cid/ciaa1865] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Aspergillus polymerase chain reaction testing of blood and respiratory samples has recently been included in the second revision of the EORTC/MSGERC definitions for classifying invasive fungal disease. This is a result of considerable efforts to standardize methodology, the availability of commercial assays and external quality control programs, and additional clinical validation. This supporting article provides both clinical and technical justifications for its inclusion while also summarizing recent advances and likely future developments in the molecular diagnosis of invasive aspergillosis.
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Affiliation(s)
- P Lewis White
- Public Health Wales Mycology Reference Laboratory, Cardiff, United Kingdom
| | - Stephane Bretagne
- Mycology Laboratory, Saint Louis Hospital, Paris and Université de Paris, France
| | - Angela M Caliendo
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Juergen Loeffler
- Department of Molecular Biology and Infection, University Hospital Wuerzburg, Medical Hospital II, Wuerzburg, Germany
| | - Thomas F Patterson
- Department of Medicine, University of Texas Health San Antonio and the South Texas Veterans Health Care System, San Antonio, Texas, USA
| | - Monica Slavin
- National Centre for Infections in Cancer, Sir Peter MacCallum Department of Medical Oncology, University of Melbourne, Melbourne, Australia
| | - John R Wingard
- Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
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38
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8th European Conference on Infections in Leukaemia: 2020 guidelines for the diagnosis, prevention, and treatment of invasive fungal diseases in paediatric patients with cancer or post-haematopoietic cell transplantation. Lancet Oncol 2021; 22:e254-e269. [PMID: 33811813 DOI: 10.1016/s1470-2045(20)30723-3] [Citation(s) in RCA: 80] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 11/16/2020] [Accepted: 11/17/2020] [Indexed: 11/24/2022]
Abstract
Paediatric patients with cancer and those undergoing allogeneic haematopoietic cell transplantation have an increased susceptibility to invasive fungal diseases. In addition to differences in underlying conditions and comorbidities relative to adults, invasive fungal diseases in infants, children, and adolescents are unique in terms of their epidemiology, the validity of current diagnostic methods, the pharmacology and dosing of antifungal agents, and the absence of phase 3 clinical trials to provide data to guide evidence-based interventions. To re-examine the state of knowledge and to further improve invasive fungal disease diagnosis, prevention, and management, the 8th European Conference on Infections in Leukaemia (ECIL-8) reconvened a Paediatric Group to review the literature and to formulate updated recommendations according to the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and European Confederation of Medical Mycology (ECMM) grading system, which are summarised in this Review.
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39
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Springer J, Held J, Mengoli C, Schlegel PG, Gamon F, Träger J, Kurzai O, Einsele H, Loeffler J, Eyrich M. Diagnostic Performance of (1→3)-β-D-Glucan Alone and in Combination with Aspergillus PCR and Galactomannan in Serum of Pediatric Patients after Allogeneic Hematopoietic Stem Cell Transplantation. J Fungi (Basel) 2021; 7:jof7030238. [PMID: 33810069 PMCID: PMC8004996 DOI: 10.3390/jof7030238] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 03/17/2021] [Accepted: 03/18/2021] [Indexed: 01/28/2023] Open
Abstract
Data on biomarker-assisted diagnosis of invasive aspergillosis (IA) in pediatric patients is scarce. Therefore, we conducted a cohort study over two years including 404 serum specimens of 26 pediatric patients after allogeneic hematopoietic stem cell transplantation (alloSCT). Sera were tested prospectively twice weekly for Aspergillus-specific DNA, galactomannan (GM), and retrospectively for (1→3)-β-D-glucan (BDG). Three probable IA and two possible invasive fungal disease (IFD) cases were identified using the European Organization for Research and Treatment of Cancer and the Mycoses Study Group (EORTC/MSGERC) 2019 consensus definitions. Sensitivity and specificity for diagnosis of probable IA and possible IFD was 80% (95% confidential interval (CI): 28–99%) and 55% (95% CI: 32–77%) for BDG, 40% (95% CI: 5–85%) and 100% (95% CI: 83–100%) for GM, and 60% (95% CI: 15–95%) and 95% (95% CI: 75–100%) for Aspergillus-specific real-time PCR. However, sensitivities have to be interpreted with great caution due to the limited number of IA cases. Interestingly, the low specificity of BDG was largely caused by false-positive BDG results that clustered around the date of alloSCT. The following strategies were able to increase BDG specificity: two consecutive positive BDG tests for diagnosis (specificity 80% (95% CI: 56–94%)); using an optimized cutoff value of 306 pg/mL (specificity 90% (95% CI: 68–99%)) and testing BDG only after the acute posttransplant phase. In summary, BDG can help to diagnose IA in pediatric alloSCT recipients. However, due to the poor specificity either an increased cutoff value should be utilized or BDG results should be confirmed by an alternative Aspergillus assay.
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Affiliation(s)
- Jan Springer
- Department for Internal Medicine II, University Hospital of Würzburg, 97080 Würzburg, Germany; (F.G.); (H.E.); (J.L.)
- Correspondence: ; Tel.: +49-931-201-36404; Fax: +49-931-201-36409
| | - Jürgen Held
- Mikrobiologisches Institut—Klinische Mikrobiologie, Immunologie und Hygiene, Universitätsklinikum Erlangen und Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, 91054 Erlangen, Germany; (J.H.); (J.T.)
| | - Carlo Mengoli
- Department of Histology, Microbiology, and Medical Biotechnology, University of Padua, 35122 Padua, Italy;
| | - Paul Gerhardt Schlegel
- Kinderklinik und Poliklinik, University Medical Center Würzburg, 97080 Würzburg, Germany; (P.G.S.); (M.E.)
| | - Florian Gamon
- Department for Internal Medicine II, University Hospital of Würzburg, 97080 Würzburg, Germany; (F.G.); (H.E.); (J.L.)
| | - Johannes Träger
- Mikrobiologisches Institut—Klinische Mikrobiologie, Immunologie und Hygiene, Universitätsklinikum Erlangen und Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, 91054 Erlangen, Germany; (J.H.); (J.T.)
| | - Oliver Kurzai
- National Reference Center for Invasive Fungal Infections (NRZMyk), Leibniz Institute for Natural Product Research and Infection Biology, Hans Knöll Institute, 07745 Jena, Germany;
- Institute for Hygiene and Microbiology, University Würzburg, 97080 Würzburg, Germany
| | - Hermann Einsele
- Department for Internal Medicine II, University Hospital of Würzburg, 97080 Würzburg, Germany; (F.G.); (H.E.); (J.L.)
| | - Juergen Loeffler
- Department for Internal Medicine II, University Hospital of Würzburg, 97080 Würzburg, Germany; (F.G.); (H.E.); (J.L.)
| | - Matthias Eyrich
- Kinderklinik und Poliklinik, University Medical Center Würzburg, 97080 Würzburg, Germany; (P.G.S.); (M.E.)
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40
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Luckowitsch M, Rudolph H, Bochennek K, Porto L, Lehrnbecher T. Central Nervous System Mold Infections in Children with Hematological Malignancies: Advances in Diagnosis and Treatment. J Fungi (Basel) 2021; 7:168. [PMID: 33652605 PMCID: PMC7996787 DOI: 10.3390/jof7030168] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 02/21/2021] [Accepted: 02/22/2021] [Indexed: 12/11/2022] Open
Abstract
The incidence of invasive mold disease (IMD) has significantly increased over the last decades, and IMD of the central nervous system (CNS) is a particularly severe form of this infection. Solid data on the incidence of CNS IMD in the pediatric setting are lacking, in which Aspergillus spp. is the most prevalent pathogen, followed by mucorales. CNS IMD is difficult to diagnose, and although imaging tools such as magnetic resonance imaging have considerably improved, these techniques are still unspecific. As microscopy and culture have a low sensitivity, non-culture-based assays such as the detection of fungal antigens (e.g., galactomannan or beta-D-glucan) or the detection of fungal nucleic acids by molecular assays need to be validated in children with suspected CNS IMD. New and potent antifungal compounds helped to improve outcome of CNS IMD, but not all agents are approved for children and a pediatric dosage has not been established. Therefore, studies have to rapidly evaluate dosage, safety and efficacy of antifungal compounds in the pediatric setting. This review will summarize the current knowledge on diagnostic tools and on the management of CNS IMD with a focus on pediatric patients.
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Affiliation(s)
- Marie Luckowitsch
- Division of Pediatric Hematology and Oncology, Hospital for Children and Adolescents, University Hospital Frankfurt, Goethe University, 60590 Frankfurt am Main, Germany; (M.L.); (H.R.); (K.B.)
| | - Henriette Rudolph
- Division of Pediatric Hematology and Oncology, Hospital for Children and Adolescents, University Hospital Frankfurt, Goethe University, 60590 Frankfurt am Main, Germany; (M.L.); (H.R.); (K.B.)
| | - Konrad Bochennek
- Division of Pediatric Hematology and Oncology, Hospital for Children and Adolescents, University Hospital Frankfurt, Goethe University, 60590 Frankfurt am Main, Germany; (M.L.); (H.R.); (K.B.)
| | - Luciana Porto
- Institute for Neuroradiology, University Hospital Frankfurt, Goethe University, 60590 Frankfurt am Main, Germany;
| | - Thomas Lehrnbecher
- Division of Pediatric Hematology and Oncology, Hospital for Children and Adolescents, University Hospital Frankfurt, Goethe University, 60590 Frankfurt am Main, Germany; (M.L.); (H.R.); (K.B.)
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41
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Chen Z, Jiang Y, Wang D, Zheng M, Liu X, Yuan C. Enhancement in serum (1-3)-β-D-glucan level by cutaneous alternariosis: A case report and literature review. Microb Pathog 2020; 150:104703. [PMID: 33347963 DOI: 10.1016/j.micpath.2020.104703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 11/24/2020] [Accepted: 12/06/2020] [Indexed: 12/22/2022]
Abstract
Contamination with the fungus Alternaria spp. is often considered to have originated from laboratory sources, which occasionally causes infection in immunocompromised patients, termed as phaeohyphomycosis. Here, we have reported a case of cutaneous alternariosis caused by Alternaria alternata. This diagnosis was based on microscopic examination and mycological culturing of patient's vesicular lesions, with the use of 5 molecular markers (namely, ITS, ATPase, Actin, rpb2, and tef1) for strain identification. We noted that Alternaria infection caused an increase in the serum level of (1-3)-β-D-glucan (BG) in the patients. To the best of our knowledge, no such finding has been reported in previously in the literature.
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Affiliation(s)
- Zongyao Chen
- Department of Clinical Laboratory, People's Hospital of Deyang City, Deyang, China.
| | - Yayun Jiang
- Department of Clinical Laboratory, People's Hospital of Deyang City, Deyang, China.
| | - Dengchao Wang
- Department of Clinical Laboratory, People's Hospital of Deyang City, Deyang, China.
| | - Mao Zheng
- Department of Clinical Laboratory, People's Hospital of Deyang City, Deyang, China.
| | - Xiao Liu
- Department of Clinical Laboratory, People's Hospital of Deyang City, Deyang, China.
| | - Chengliang Yuan
- Department of Clinical Laboratory, People's Hospital of Deyang City, Deyang, China.
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Zinter MS, Dvorak CC, Auletta JJ. How We Treat Fever and Hypotension in Pediatric Hematopoietic Cell Transplant Patients. Front Oncol 2020; 10:581447. [PMID: 33042850 PMCID: PMC7526343 DOI: 10.3389/fonc.2020.581447] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 08/24/2020] [Indexed: 11/13/2022] Open
Abstract
Pediatric allogeneic hematopoietic cell transplant (HCT) survival is limited by the development of post-transplant infections. In this overview, we discuss a clinical approach to the prompt recognition and treatment of fever and hypotension in pediatric HCT patients. Special attention is paid to individualized hemodynamic resuscitation, thorough diagnostic testing, novel anti-pathogen therapies, and the multimodal support required for recovery. We present three case vignettes that illustrate the complexities of post-HCT sepsis and highlight best practices that contribute to optimal transplant survival in children.
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Affiliation(s)
- Matt S Zinter
- Division of Critical Care Medicine, UCSF Benioff Children's Hospital, University of California, San Francisco, San Francisco, CA, United States
| | - Christopher C Dvorak
- Division of Allergy, Immunology, and Blood and Marrow Transplantation, UCSF Benioff Children's Hospital, University of California, San Francisco, San Francisco, CA, United States
| | - Jeffery J Auletta
- Division of Hematology, Oncology, Blood and Marrow Transplantation, Nationwide Children's Hospital, Columbus, OH, United States.,Division of Infectious Diseases, Nationwide Children's Hospital, Columbus, OH, United States
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Donnelly JP, Chen SC, Kauffman CA, Steinbach WJ, Baddley JW, Verweij PE, Clancy CJ, Wingard JR, Lockhart SR, Groll AH, Sorrell TC, Bassetti M, Akan H, Alexander BD, Andes D, Azoulay E, Bialek R, Bradsher RW, Bretagne S, Calandra T, Caliendo AM, Castagnola E, Cruciani M, Cuenca-Estrella M, Decker CF, Desai SR, Fisher B, Harrison T, Heussel CP, Jensen HE, Kibbler CC, Kontoyiannis DP, Kullberg BJ, Lagrou K, Lamoth F, Lehrnbecher T, Loeffler J, Lortholary O, Maertens J, Marchetti O, Marr KA, Masur H, Meis JF, Morrisey CO, Nucci M, Ostrosky-Zeichner L, Pagano L, Patterson TF, Perfect JR, Racil Z, Roilides E, Ruhnke M, Prokop CS, Shoham S, Slavin MA, Stevens DA, Thompson GR, Vazquez JA, Viscoli C, Walsh TJ, Warris A, Wheat LJ, White PL, Zaoutis TE, Pappas PG. Revision and Update of the Consensus Definitions of Invasive Fungal Disease From the European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium. Clin Infect Dis 2020; 71:1367-1376. [PMID: 31802125 PMCID: PMC7486838 DOI: 10.1093/cid/ciz1008] [Citation(s) in RCA: 1342] [Impact Index Per Article: 335.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 10/08/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Invasive fungal diseases (IFDs) remain important causes of morbidity and mortality. The consensus definitions of the Infectious Diseases Group of the European Organization for Research and Treatment of Cancer and the Mycoses Study Group have been of immense value to researchers who conduct clinical trials of antifungals, assess diagnostic tests, and undertake epidemiologic studies. However, their utility has not extended beyond patients with cancer or recipients of stem cell or solid organ transplants. With newer diagnostic techniques available, it was clear that an update of these definitions was essential. METHODS To achieve this, 10 working groups looked closely at imaging, laboratory diagnosis, and special populations at risk of IFD. A final version of the manuscript was agreed upon after the groups' findings were presented at a scientific symposium and after a 3-month period for public comment. There were several rounds of discussion before a final version of the manuscript was approved. RESULTS There is no change in the classifications of "proven," "probable," and "possible" IFD, although the definition of "probable" has been expanded and the scope of the category "possible" has been diminished. The category of proven IFD can apply to any patient, regardless of whether the patient is immunocompromised. The probable and possible categories are proposed for immunocompromised patients only, except for endemic mycoses. CONCLUSIONS These updated definitions of IFDs should prove applicable in clinical, diagnostic, and epidemiologic research of a broader range of patients at high-risk.
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Affiliation(s)
| | - Sharon C Chen
- Centre for Infectious Diseases and Microbiology, Laboratory Services, Institute of Clinical Pathology and Medical Research, Westmead Hospital, University of Sydney, Sydney, Australia
| | - Carol A Kauffman
- Division of Infectious Diseases, University of Michigan, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - William J Steinbach
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina, USA
| | - John W Baddley
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Paul E Verweij
- Center of Expertise in Mycology Radboudumc/CWZ, Nijmegen, The Netherlands
| | | | - John R Wingard
- Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Shawn R Lockhart
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Andreas H Groll
- Infectious Disease Research Program, Center for Bone Marrow Transplantation and Department of Pediatric Hematology and Oncology University Children’s Hospital, Münster, Germany
| | - Tania C Sorrell
- University of Sydney, Marie Bashir Institute for Infectious Diseases & Biosecurity, University of Sydney School of Medicine Faculty of Medicine and Health, Westmead Institute for Centre for Infectious Diseases and Microbiology, Western Sydney Local Health District, Sydney, Australia
| | - Matteo Bassetti
- Infectious Disease Clinic, Department of Medicine University of Udine and Department of Health Sciences, DISSAL, University of Genoa, Genoa, Italy
| | - Hamdi Akan
- Ankara University, Faculty of Medicine, Cebeci Campus, Hematology Clinical Research Unit, Ankara, Turkey
| | - Barbara D Alexander
- Department of Medicine and Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA
| | - David Andes
- Division of Infectious Diseases, Departments of Medicine, Microbiology and Immunology School of Medicine and Public Health and School of Pharmacy, University of Wisconsin, Madison, Wisconsin, USA
| | - Elie Azoulay
- Médicine Intensive et Réanimation Hôpital Saint-Louis, APHP, Université Paris Diderot, Paris, France
| | - Ralf Bialek
- Molecular Diagnostics of Infectious Diseases, Microbiology, LADR Zentrallabor Dr. Kramer & Kollegen, Geesthacht, Germany
| | - Robert W Bradsher
- Division of Infectious Diseases, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Stephane Bretagne
- Institut Pasteur, Molecular Mycology Unit, CNRS UMR2000, Mycology Laboratory, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Thierry Calandra
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Angela M Caliendo
- Department of Medicine, Alpert Warren Medical School of Brown University, Providence, Rhode Island, USA
| | - Elio Castagnola
- Infectious Diseases Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Mario Cruciani
- Infectious Diseases Unit, G. Fracastoro Hospital, San Bonifacio, Verona, Italy
| | | | - Catherine F Decker
- Infectious Diseases Division, Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Sujal R Desai
- National Heart & Lung Institute, Imperial College London, the Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Brian Fisher
- Pediatric Infectious Diseases Division at the Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Thomas Harrison
- Centre for Global Health, Institute for Infection and Immunity, St Georges University of London, London, UK
| | - Claus Peter Heussel
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Translational Lung Research Center and Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik Heidelberg, Heidelberg, Germany
| | - Henrik E Jensen
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Bart-Jan Kullberg
- Radboud Center for Infectious Diseases and Department of Medicine, Radboudumc, Nijmegen, The Netherlands
| | - Katrien Lagrou
- Department of Microbiology, Immunology and Transplantation and Department of Laboratory Medicine and National Reference Centre for Mycosis, University Hospitals Leuven, Leuven, Belgium
| | - Frédéric Lamoth
- Infectious Diseases Service, Department of Medicine and Institute of Microbiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Thomas Lehrnbecher
- Pediatric Hematology and Oncology, Hospital for Children and Adolescents, University of Frankfurt, Frankfurt, Germany
| | - Jurgen Loeffler
- Molecular Biology and Infection, Medical Hospital II, WÜ4i, University Hospital Würzburg, Würzburg, Germany
| | - Olivier Lortholary
- Paris University, Necker Pasteur Center for Infectious Diseases and Tropical Medicine, IHU Imagine & Institut Pasteur, Molecular Mycology Unit, CNRS UMR 2000, Paris, France
| | - Johan Maertens
- Department of Hematology, University Hospitals Leuven, Leuven, Belgium
- Department of Microbiology, Immunology and Transplantation, K.U. Leuven, Leuven, Belgium
| | - Oscar Marchetti
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Kieren A Marr
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School
| | - Henry Masur
- Critical Care Medicine Department NIH-Clinical Center, Bethesda, Maryland, USA
| | - Jacques F Meis
- Department of Medical Microbiology and Infectious Diseases and Centre of Expertise in Mycology Radboudumc/Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | | | - Marcio Nucci
- Department of Internal Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Livio Pagano
- Istituto di Ematologia, Università Cattolica S. Cuore, Rome, Italy
| | - Thomas F Patterson
- UT Health San Antonio and South Texas Veterans Health Care System, San Antonio, Texas, USA
| | - John R Perfect
- Department of Medicine and Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA
| | - Zdenek Racil
- Department of Internal Medicine–Hematology and Oncology, Masaryk University and University Hospital Brno, Brno, Czech Republic
| | - Emmanuel Roilides
- Infectious Diseases Unit, 3rd Department of Pediatrics, Faculty of Medicine, Aristotle University School of Health Sciences, Hippokration General Hospital, Thessaloniki, Greece
| | - Marcus Ruhnke
- Department of Hematology & Oncology, Lukas Hospital, Buende, Germany
| | - Cornelia Schaefer Prokop
- Meander Medical Center Amersfoort and Radiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Shmuel Shoham
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School
| | - Monica A Slavin
- Department of Infectious Diseases, Peter MacCallum Cancer Center and the National Centre for Infections in Cancer, The University of Melbourne, Melbourne, Victoria, Australia
| | - David A Stevens
- Division of Infectious Diseases and Geographic Medicine, Stanford University Medical School, Stanford, California
- California Institute for Medical Research, San Jose, California, USA
| | - George R Thompson
- Department of Internal Medicine, Division of Infectious Diseases, University of California Davis Medical Center, Sacramento, California, USA
| | - Jose A Vazquez
- Division of Infectious Diseases, Medical College of Georgia/Augusta University, Augusta, Georgia, USA
| | - Claudio Viscoli
- Division of Infectious Disease, University of Genova and San Martino University Hospital, Genova, Italy
| | - Thomas J Walsh
- Weill Cornell Medicine of Cornell University, Departments of Medicine, Pediatrics, Microbiology & Immunology, New York, New York, USA
| | - Adilia Warris
- MRC Centre for Medical Mycology at the University of Aberdeen, Aberdeen, UK
| | | | - P Lewis White
- Public Health Wales Mycology Reference Laboratory, University Hospital of Wales, Heath Park, Cardiff, UK
| | - Theoklis E Zaoutis
- Perelman School of Medicine at the University of Pennsylvania, Children’s Hospital of Philadelphia and Roberts Center for Pediatric Research, Philadelphia, Pennsylvania, USA
| | - Peter G Pappas
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Assessment of Serum Galactomannan Test Results of Pediatric Patients With Hematologic Malignancies According to Consecutive Positivity and Threshold Level in Terms of Invasive Aspergillosis Diagnosis: Cross-Sectional Research in a Tertiary Care Hospital. J Pediatr Hematol Oncol 2020; 42:e271-e276. [PMID: 31725542 DOI: 10.1097/mph.0000000000001653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of this study was to evaluate the diagnostic utility of serum galactomannan (GM) positivity for invasive aspergillosis (IA) in children. Positive GM results between January 2015 and August 2017 were reviewed retrospectively in children with hematologic malignancies. Single and consecutive positive GM results were evaluated according to the different galactomannan index (GMI) (>0.5, >0.7, >1.0 and >1.5) values. There were 104 positive GM results of 70 patients. IA was identified in 29 patients (41.4%) (2 proven and 27 probable). For a single positive GMI of >0.5, >0.7, >1.0, and >1.5, the numbers were 104, 76, 57, and 32 and the positive predictive values (PPVs) were 39.4%, 43.2%, 47.2%, and 50.0%, respectively. The single GM positivity at different thresholds showed no difference between the IA and non-IA group (P>0.05). For 2 consecutive positive GMI values of >0.5, >0.7, >1.0, and >1.5, the numbers were 34, 20, 13, and 4, and the PPVs were 58.8%, 65.0%, 84.6%, and 100.0%, respectively. In the IA group, positivity was higher at all thresholds (P<0.05). According to our findings, consecutive GM positivity has higher PPVs independently from the cutoff value chosen. In pediatric patients with high risk, consecutive sampling should be preferred.
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Delgado-Araneda M, Valenzuela R, de la Maza V, Rabello M, Álvarez AM, Contardo V, Zubieta M, Gutierrez V, Claverie X, Torres JP, Salgado C, Tordecilla J, Varas M, Avilés CL, Venegas M, Villarroel M, Santolaya ME. Usefulness of serum galactomannan in initiating and modifying antifungal therapy in children with cancer and persistent high-risk febrile neutropenia. Mycoses 2020; 63:802-811. [PMID: 32347600 DOI: 10.1111/myc.13097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 04/20/2020] [Accepted: 04/21/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Invasive fungal disease is a major cause of morbidity and mortality in children with cancer and high-risk febrile neutropenia (HRFN). Repeated serum galactomannan (sGM) measurements have been described as an effective tool to guide therapy in adults under suspicion of invasive aspergillosis. However, the utility of this approach has not been reported in paediatric population. OBJECTIVES To evaluate the usefulness of sGM measurements in initiating and modifying antifungal therapy (AFT) in children with cancer and persistent HRFN. PATIENTS/METHODS Nested case-control study in children with cancer and persistent HRFN episodes, between July 2013 and January 2019. Patients were classified as cases and controls depending on if they received AFT or not, respectively. Through odds ratio analysis, we assessed the role of sGM positivity in the AFT initiation decision. Then, we analysed the group of patients that initiated AFT, and compared those who had AFT modifications and those who did not, analysing different sGM kinetics thresholds. RESULTS A total of 191 episodes from children with persistent HRFN were enrolled, of which 107 received AFT and 84 did not. The median age was 7 years (IQR 4-12), 52% were male and 89% had a haematologic malignancy as underlying disease. Positive sGM was not associated with AFT initiation (OR 0.99, 95% CI 0.43-2.33, P = .99). A difference threshold in sGM Δ ≥ 0.3 sGM was significantly associated with AFT modification (OR 5.07, 95% CI 1.02- 25.70, P = .04). CONCLUSIONS Our results suggest the utility of serial sGM sampling during AFT in children with persistent HRFN.
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Affiliation(s)
- Matías Delgado-Araneda
- Department of Pediatrics, Residency and Medical Sciences Doctorate Program, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Romina Valenzuela
- Department of Pediatrics, Faculty of Medicine, Hospital Dr. Luis Calvo Mackenna, Universidad de Chile, Santiago, Chile
| | - Verónica de la Maza
- Department of Pediatrics, Faculty of Medicine, Hospital Dr. Luis Calvo Mackenna, Universidad de Chile, Santiago, Chile
| | - Marcela Rabello
- Department of Pediatrics, Faculty of Medicine, Hospital Dr. Luis Calvo Mackenna, Universidad de Chile, Santiago, Chile
| | - Ana M Álvarez
- Department of Pediatrics, Faculty of Medicine, Hospital San Juan de Dios, Universidad de Chile, Santiago, Chile.,Committee of Infectious Diseases, National Child Programme of Antineoplastic Drugs (PINDA), Santiago, Chile
| | - Verónica Contardo
- Department of Pediatrics, Faculty of Medicine, Hospital Roberto del Río, Universidad de Chile, Santiago, Chile.,Committee of Infectious Diseases, National Child Programme of Antineoplastic Drugs (PINDA), Santiago, Chile
| | - Marcela Zubieta
- Department of Pediatrics, Hospital Exequiel González Cortés, Faculty of Medicine, Universidad de Chile, Santiago, Chile.,Committee of Infectious Diseases, National Child Programme of Antineoplastic Drugs (PINDA), Santiago, Chile
| | - Valentina Gutierrez
- Department of Pediatrics, Hospital Dr. Sótero del Río, Santiago, Chile.,Committee of Infectious Diseases, National Child Programme of Antineoplastic Drugs (PINDA), Santiago, Chile
| | - Ximena Claverie
- Department of Pediatrics, Hospital Dr. Sótero del Río, Santiago, Chile.,Committee of Infectious Diseases, National Child Programme of Antineoplastic Drugs (PINDA), Santiago, Chile
| | - Juan P Torres
- Department of Pediatrics, Faculty of Medicine, Hospital Dr. Luis Calvo Mackenna, Universidad de Chile, Santiago, Chile
| | - Carmen Salgado
- Department of Pediatrics, Hospital Exequiel González Cortés, Faculty of Medicine, Universidad de Chile, Santiago, Chile.,Committee of Infectious Diseases, National Child Programme of Antineoplastic Drugs (PINDA), Santiago, Chile
| | - Juan Tordecilla
- Department of Pediatrics, Faculty of Medicine, Hospital Roberto del Río, Universidad de Chile, Santiago, Chile.,Committee of Infectious Diseases, National Child Programme of Antineoplastic Drugs (PINDA), Santiago, Chile
| | - Mónica Varas
- Department of Pediatrics, Faculty of Medicine, Hospital San Juan de Dios, Universidad de Chile, Santiago, Chile.,Committee of Infectious Diseases, National Child Programme of Antineoplastic Drugs (PINDA), Santiago, Chile
| | - Carmen L Avilés
- Department of Pediatrics, Faculty of Medicine, Hospital San Borja Arriarán, Universidad de Chile, Santiago, Chile.,Committee of Infectious Diseases, National Child Programme of Antineoplastic Drugs (PINDA), Santiago, Chile
| | - Marcela Venegas
- Department of Pediatrics, Faculty of Medicine, Hospital San Borja Arriarán, Universidad de Chile, Santiago, Chile.,Committee of Infectious Diseases, National Child Programme of Antineoplastic Drugs (PINDA), Santiago, Chile
| | - Milena Villarroel
- Department of Pediatrics, Faculty of Medicine, Hospital Dr. Luis Calvo Mackenna, Universidad de Chile, Santiago, Chile.,Committee of Infectious Diseases, National Child Programme of Antineoplastic Drugs (PINDA), Santiago, Chile
| | - María E Santolaya
- Department of Pediatrics, Faculty of Medicine, Hospital Dr. Luis Calvo Mackenna, Universidad de Chile, Santiago, Chile.,Committee of Infectious Diseases, National Child Programme of Antineoplastic Drugs (PINDA), Santiago, Chile
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Abstract
Appropriate diagnosis of invasive fungal infections (IFIs) is critical due to the high rates of morbidity and mortality, as well as the substantial economic burden, associated with the management of these diseases. The recognition of IFI and differentiation from other infections with similar clinical presentations can be challenging, which can lead to diagnostic error that not only has an impact on individual patient health outcomes but also on antimicrobial drug usage and the growing threat of antimicrobial resistance in bacteria. Therefore, there is a significant need for improved stewardship related to diagnostic testing for and treatment of IFIs. The purpose of this review is to highlight recent advances related to current fungal diagnostics, as well as explore some of the most innovative technology that has emerged with the potential to shift the paradigm of clinical mycology. In general, this review will discuss research related to enhanced fungal culture utilization and identification techniques, expanded applications of fungal antigen testing, and recently developed molecular assays and other novel nonculture fungal diagnostic approaches. Specifically, the application of mass spectrometry, novel glycobiomarker detection, and detection of fungal-specific volatile organic compounds will be reviewed, along with other key updates, to provide the reader with an updated review that extends beyond the basics of IFI laboratory diagnostics. Where appropriate, the reader will be directed to more comprehensive reviews of certain aspects of clinical mycology laboratory testing to provide a broader context for the critical consideration of these updates.
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Otto WR, Green AM. Fungal infections in children with haematologic malignancies and stem cell transplant recipients. Br J Haematol 2020; 189:607-624. [PMID: 32159231 DOI: 10.1111/bjh.16452] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 10/23/2019] [Indexed: 12/11/2022]
Abstract
Children with haematologic malignancies and haematopoietic stem cell transplant recipients are at high risk for invasive fungal diseases (IFD). There has been an increased number of at-risk children over the past two decades due to improvements in cancer therapies resulting in improved survival of children with high-risk and refractory malignancies. The predominant organisms that cause IFD include Candida spp., Aspergillus spp. and the Mucorales molds. Clinical presentations of IFD vary based on host immune status and the causative organism. Though serum biomarkers such as the galactomannan assay and beta-D-glucan assay have been validated in adults, there are limited data regarding their diagnostic value in children. Thus, the gold standard for IFD diagnosis remains tissue biopsy with histopathological and microbiological evaluation. Treatment of IFD is multimodal and involves antifungal drugs, correction of immune dysfunction and surgical resection when feasible. Paediatric practice regarding IFD is largely extrapolated from data generated in adult patients; in this review, we evaluate both primary paediatric studies and guidelines intended for adult patients that are applied to paediatric patients. There remain significant knowledge gaps with respect to the prevention, diagnosis and treatment of IFD in immunocompromised children, and further research is needed to help guide management decisions.
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Affiliation(s)
- William R Otto
- Division of Infectious Diseases, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Abby M Green
- Division of Infectious Diseases, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Division of Oncology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Division of Infectious Diseases, Department of Pediatrics, Washington University, St. Louis, MO, USA
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Mercier T, Wera J, Chai LYA, Lagrou K, Maertens J. A Mortality Prediction Rule for Hematology Patients with Invasive Aspergillosis Based on Serum Galactomannan Kinetics. J Clin Med 2020; 9:jcm9020610. [PMID: 32102465 PMCID: PMC7073547 DOI: 10.3390/jcm9020610] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 02/11/2020] [Accepted: 02/19/2020] [Indexed: 12/16/2022] Open
Abstract
In invasive aspergillosis (IA), an early and adequate assessment of the response to the initial antifungal therapy remains problematic. We retrospectively analyzed 206 hematology patients with proven or probable IA, and collected serial serum galactomannan (sGM) values and survival status through week 6 and week 12. We created a model for survival at week 6 based on the sGM taken at baseline and on early sGM kinetics. This resulted in a rule predicting that patients with a baseline sGM index >1.4, who failed to lower that index to <0.5 after one week, had a mortality rate of 48.1% at week 6. Conversely, patients presenting with a baseline sGM index ≤1.4 that obtained a negative sGM (<0.5) after one week, had a mortality that was almost five times lower at only 10.1% by week 6. These findings were confirmed in an external cohort from an independent prospective study. In conclusion, sGM kinetics correlate well with treatment outcomes in hematology patients with IA. We present a rule which is easy to use at the bedside and has good accuracy in predicting week 6 survival.
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Affiliation(s)
- Toine Mercier
- KU Leuven, Department of Microbiology, Immunology and Transplantation, 3000 Leuven, Belgium; (K.L.); (J.M.)
- Department of Hematology, University Hospitals Leuven, 3000 Leuven, Belgium;
- Correspondence:
| | - Joachim Wera
- Department of Hematology, University Hospitals Leuven, 3000 Leuven, Belgium;
| | - Louis Y. A. Chai
- Division of Infectious Diseases, University Medicine Cluster, National University Health System, Singapore and Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119074, Singapore;
| | - Katrien Lagrou
- KU Leuven, Department of Microbiology, Immunology and Transplantation, 3000 Leuven, Belgium; (K.L.); (J.M.)
- Department of Laboratory Medicine and National Reference Center for Mycosis, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Johan Maertens
- KU Leuven, Department of Microbiology, Immunology and Transplantation, 3000 Leuven, Belgium; (K.L.); (J.M.)
- Department of Hematology, University Hospitals Leuven, 3000 Leuven, Belgium;
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49
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Parente R, Doni A, Bottazzi B, Garlanda C, Inforzato A. The complement system in Aspergillus fumigatus infections and its crosstalk with pentraxins. FEBS Lett 2020; 594:2480-2501. [PMID: 31994174 DOI: 10.1002/1873-3468.13744] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 12/19/2019] [Accepted: 01/16/2020] [Indexed: 12/13/2022]
Abstract
Aspergillosis is a life-threatening infection mostly affecting immunocompromised individuals and primarily caused by the saprophytic fungus Aspergillus fumigatus. At the host-pathogen interface, both cellular and humoral components of the innate immune system are increasingly acknowledged as essential players in the recognition and disposal of this opportunistic mold. Fundamental hereof is the contribution of the complement system, which deploys all three activation pathways in the battle against A. fumigatus, and functionally cooperates with other soluble pattern recognition molecules, including pentraxins. In particular, preclinical and clinical observations point to the long pentraxin PTX3 as a nonredundant and complement-dependent effector with protective functions against A. fumigatus. Based on past and current literature, here we discuss how the complement participates in the immune response to this fungal pathogen, and illustrate its crosstalk with the pentraxins, with a focus on PTX3. Emphasis is placed on the molecular mechanisms underlying such processes, the genetic evidence from human epidemiology, and the translational potential of the currently available knowledge.
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Affiliation(s)
- Raffaella Parente
- Department of Immunology and Inflammation, Humanitas Clinical and Research Institute - IRCCS, Milan, Italy
| | - Andrea Doni
- Department of Immunology and Inflammation, Humanitas Clinical and Research Institute - IRCCS, Milan, Italy
| | - Barbara Bottazzi
- Department of Immunology and Inflammation, Humanitas Clinical and Research Institute - IRCCS, Milan, Italy
| | - Cecilia Garlanda
- Department of Immunology and Inflammation, Humanitas Clinical and Research Institute - IRCCS, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Antonio Inforzato
- Department of Immunology and Inflammation, Humanitas Clinical and Research Institute - IRCCS, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
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50
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Bochennek K, Luckowitsch M, Lehrnbecher T. Recent advances and future directions in the management of the immunocompromised host. Semin Oncol 2020; 47:40-47. [DOI: 10.1053/j.seminoncol.2020.02.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 02/05/2020] [Accepted: 02/05/2020] [Indexed: 02/07/2023]
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