Detection of β-D-glucan for the diagnosis of invasive fungal infection in children with hematological malignancy

•One of the first study showing the value of β-D-glucan to diagnose IFI in Pediatrics.•Performances of test improved in patients not previously treated with antifungals.•β-D-glucan seric levels correlate the clinical outcome of invasive fungal infection.•Interpretation must always be cautious due to a high rate of false-positivity.•Recent administration of immunoglobulins is the main cause of false-positivity.

SummaryObjectivesThe ß-D-glucan assay (BDG) has been added to the EORTC/MSG criteria for the diagnosis of invasive fungal infections (IFI), but data from pediatric populations is scarce. The aim of this study was to evaluate performance of BDG in a cohort of hemato-oncological children with hematological malignancy at risk for IFI.Methods113 patients were included through an 18-month period. In addition to routine IFI screening, BDG was assayed once a week. IFIs were classified using EORTC/MSG criteria without including the BDG results. Performances were assessed after a ROC analysis for optimization and multivariate analysis to detect the causes of false positivity.Results8 proven and 4 probable IFIs, and 7 possible IFIs were diagnosed in 9 and 7 patients, respectively. Sensitivity and specificity increased from 75% and 56% to 100% and 91.1%, respectively when considering the whole population and patients not having received any antifungals prior to the test. Multivariate analysis revealed that being younger than 7, severe colitis/mucositis, recent administration of polyvalent immunoglobulins and digestive colonization with Enterococcus sp were independent risk factors for false positivity.ConclusionsBDG is a valuable test to detect IFI in pediatric patients not previously treated with antifungals and to detect the occurrence of chronic infection.