Value of plasma β-Glucan in early diagnosis of invasive fungal infection in children

Abstract:

OBJECTIVE: The incidence of invasive fungal infection (IFI) has risen dramatically along with the prolongation of immunocompromised individuals′ lifespan. This study aimed to investigate the incidence of IFI among highrisk pediatric patients and to evaluate the diagnostic value of circulating (1，3)-β-D-glucan (BG) in IFI. METHODS: High-risk pediatric inpatients from hemato-oncology department and ICU were enrolled from November 2007 to June 2008. All the patients had persistent fever for 4 to 7 days or longer. Circulating BG levels were detected once or twice weekly until the signs and symptoms improved, or IFI was excluded, or death. Circulating BG levels were determined by the GKT-5M Set Kinetic Fungus Detection Kit. Detection of plasma BG was judged positive when the level was ≥10 pg/mL. RESULTS: A total of 130 patients were enrolled. Two patients with candidemia were classified as proven IFI, 20 as probale IFI, 7 as possible IFI, and 101 without IFI. The patients with proven or probable IFI had a longer length of hospital stay (P＜0.05) and an increased mortality rate (P＜0.05）. The patients with IFI demonstrated a higher plasma level of BG than those without IFI (P＜0.01）. The sensitivity, specificity, positive and negative predictive values for plasma BG detction were 81.8%, 82.4%, 48.6% and 95.7% respectively. Positive BG results occurred before the abnormal results on computed tomography scan or fungal culture or simultaneously in 72.2% of the cases. CONCLUSIONS: IFI is not rare among pediatric high-risk patients. Circulating BG detection is accurate to a certain extent in the diagnosis of IFI. It is a useful adjunct means for IFI screening in high-risk patients.［Chin J Contemp Pediatr, 2009, 11 (11):905-908］