Prospective Aspergillus galactomannan antigen testing in pediatric hematopoietic stem cell transplant recipients.

Published

Journal Article

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.

Full Text

Duke Authors

Cited Authors

  • Steinbach, WJ; Addison, RM; McLaughlin, L; Gerrald, Q; Martin, PL; Driscoll, T; Bentsen, C; Perfect, JR; Alexander, BD

Published Date

  • July 2007

Published In

Volume / Issue

  • 26 / 7

Start / End Page

  • 558 - 564

PubMed ID

  • 17596794

Pubmed Central ID

  • 17596794

International Standard Serial Number (ISSN)

  • 0891-3668

Digital Object Identifier (DOI)

  • 10.1097/INF.0b013e3180616cbb

Language

  • eng

Conference Location

  • United States