Document Detail


Prospective Aspergillus galactomannan antigen testing in pediatric hematopoietic stem cell transplant recipients.
MedLine Citation:
PMID:  17596794     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The galactomannan (GM) assay is an approved noninvasive test for detection of invasive aspergillosis (IA) that has been validated in adult patients with hematologic malignancies who are undergoing bone marrow transplantation. There have been few studies with this assay in pediatric patients, but early reports suggest that there may be differences in the performance such that false-positive GM tests in pediatric patients are more common than in adult patients. METHODS: We performed a prospective study in pediatric hematopoietic stem cell transplant recipients with twice-weekly sampling for GM detection during the highest risk periods of neutropenia and graft-versus-host disease. We analyzed 826 serum samples from 64 patients, including 15 serum samples from one patient diagnosed with probable IA according to defined criteria. RESULTS: Twenty of 811 samples tested positive on repeat testing (specificity, 97.5%; 95% CI: 96.2-98.4%) including samples from 8 of 63 patients without clinical evidence of IA according to study criteria (specificity, 87.3%; 95% CI: 76.9-93.4%). Eleven patients received piperacillin/tazobactam therapy, and 4 of the 11 patients had a positive assay result coinciding with the dates of piperacillin/tazobactam administration. When samples from these patients were excluded, specificity increased to 98.4% (95% CI: 97.2-99.1%) by sample and to 91.5% (95% CI: 81.6-96.3%) by patient. CONCLUSIONS: The GM assay holds promise for early, noninvasive diagnosis of IA in high-risk children and false-positive results were not common or unexplainable. This study supports further validation of this assay in a large-scale, pediatric-dedicated format.
Authors:
William J Steinbach; Rachel M Addison; Lisa McLaughlin; Quincy Gerrald; Paul L Martin; Timothy Driscoll; Christopher Bentsen; John R Perfect; Barbara D Alexander
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The Pediatric infectious disease journal     Volume:  26     ISSN:  0891-3668     ISO Abbreviation:  Pediatr. Infect. Dis. J.     Publication Date:  2007 Jul 
Date Detail:
Created Date:  2007-06-28     Completed Date:  2007-08-08     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8701858     Medline TA:  Pediatr Infect Dis J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  558-64     Citation Subset:  IM    
Affiliation:
Department of Pediatrics, Duke University Medical Center, Durham, NC 27710, USA. stein022@mc.duke.edu
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MeSH Terms
Descriptor/Qualifier:
Antigens, Fungal / immunology*
Aspergillosis / diagnosis
Aspergillus / isolation & purification*
Child
Enzyme-Linked Immunosorbent Assay
Hematopoietic Stem Cell Transplantation*
Humans
Mannans / isolation & purification*
Predictive Value of Tests
Sensitivity and Specificity
Chemical
Reg. No./Substance:
0/Antigens, Fungal; 0/Mannans; 11078-30-1/galactomannan

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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