| BackgroundWith the great development of contemporary medicine,patients gained longer survival,but also the increasing incidence of opportunistic fungi infections.More cases are reported in non-neutropenic and immunocompetent children without apparent underlying conditions.The lung is the most vulnerable sites for IFI.IFI are associated with complications and can cause high morbidity and mortality.Nowadays,IFI are an increasing problem in children.Early diagnosis and prompt therapy is the key to better prognosis.Traditional methods(culture;histopathology)do not have adequate sensitivity,while the clinical features and the imaging examinations are not specific in non-neutropenic children that lead to delay or misdiagnosis.The significant value of serum 1,3-?-D-glucan(G)and galactomannan(GM)assays are reported for the early diagnosis of IPFIs in neutropenic children.But G and GM assay can be influenced by many factors.It cannot be ignored of the false positive and negative results of G and GM assay.Recently,there are few data from G and GM assays of non-neutropenic children.ObjectiveTo evaluate the value of serum G and GM assays for IPFIs in non-neutropenic children.MethodsThe study was conducted between April 2015 and March 2017 in the department of pediatric respiratory ard the pediatric intensive care unit of Provincial Hospital Affiated to Shandong University.The included criterias were as flollows.Firstly,Children with fever,cough or sighs of lung were not improved or repeated with the therapy of antibiotics for four days.Secondly,children with non-neutropenic history.Thirdlly,serum G or GM assay has been done before antifungal drugs application.The exclusion criterias were as flollows.Firstly,children who were diagnosed with fungal infection in other hospitals and have been treated with antifungal drugs.Secondly,children who used antifungal drugs for infection prevention.Thirdly,children were not diagnosed clearly and left hospitals without promise.Fourthly neonatal.The clinical data of the children were collected through the electronic medical records system.According to the criteria of "Guidelines for diagnosis and treatment of invasive pulmonary fungal infections" by Chinese Pediatric Society of Respiratory Diseases,in 2009 and the European Organization for Research and Treatment of Cancer/Mycoses Study Group revised in 2008,the patients were divided into IPFIs group(Proven and probable cases)and no-IPFIs group(no-IPFIs cases).Possible cases were excluded.And according to the rusults of culture(blood,sputum,bronchoalveolar lavage fluid),proven and probable cases who infected by aspergillosis were defined as IPA group.We made a comparison of clinical features and risk factors between IPFIs and non-IPFIs groups with SPSS 19.0,meanwhile,analyzing the value of G and GM assays.Results1.A total of 48 cases were enrolled,including 29 males and 19 females,with a ratio of 1.53:1.The onset age ranged from 1 month to 13 years(median,2.25 years).10 cases of IPFIs(4 proven,6 probable),of which 5 cases are defined as group of IPA,and 38 cases of no IPFIs.There are no statistical difference among age?sex and days of in-hospital between group of IPFIs and no-IPFIs.2.11 strains of fungi were cultured from group of IPFIs(one case was cultured Candida parapsilosis and Candida pelliculosa simultaneously)and Aspergillus species are the main pathogens.3.Group of IPFIs had at least one high risk factor for infection.8 cases(80%)use antibiotics for a long time,of which 5 cases(50%)use two or more broad-spectrum antibiotics for more than 2 weeks.6 cases stayed in hospital for more than 2 weeks.3 cases(30%)had invasive procedures.2 cases(20%)are immunocompromised and exposed to fungal environment separately.The exposure to fungal environment was statistically significant between group of IPFIs and no-IPFIs,incidence rate of exposure to fungal environment in group of IPFIs was higher than group of no-IPFI,other types of risk factors have no significant difference.4.The clinical pretentions are often associated with nonspecific in group IPFIs,including fever,productive or non-productive cough,hemoptysis or bloody sputum and dyspnea.The hemoptysis or bloody sputum was statistically significant between the two groups,incidence rate of hemoptysis or bloody sputum in group of IPFIs was higher than group of no-IPFI,other types of clinical pretentions have no significant difference.5.The imaging examinations are not specific in group IPFIs.Consolidation is the predominant feature.The halo sign and the "air-crescent" sign were not observed in the group of IPA.6.The index of serum G assay in IPFIs group[(141.84,288.88)pg ·ml-1]was significantly higher than that in no-IPFIs group[(39.22,42.71)pg·ml-1](P<0.05).The index of serum GM assay in IPFIs group[(0.76,0.66)ug · L-1]was significantly higher than that in no-IPFIs group[(0.51,0.39)ug ·L-1](P<0.05).The sensitivities,specificities,positive and negative predictive values of G assays?GM assays and parallel tests(positive result of G or GM assays)in diagnosing IPFIs were 60%/40%/70%?84.21%/89.47%/73.68%?50%/50%/41.18%?88.89%/85%/90.32%respectively.The areas under the ROC curves(AUC)for G assay and GM assay of IPFIs group was 0.786?0.817,respectively.7.The sensitivities,specificities,positive and negative predictive values of G assays?GM assays?parallel tests?tandem tests(G and GM assay was positive at same time)in diagnosing IPA were 60%/40%/60%/40%?84.21%/89.47%/73.68%/100%?33.33%133.33%/23.08%/100%?94.12%/91.89%/93.33/92.68.Conclusions1.The use of broad-spectrum antibiotics for a long time is the most common risk factor for IPFIs in children with non-neutropenic.IPFIs should be suspected in children with high risk factoer,especially for who are exposed to fungi environment.2.Both serum G assay and GM assay alone had high specificities for the diagnosis of IPFIs in children with non-neutropenic.Sensitivities of serum G assay in diagnosing is more higher than serum GM assay.Serum G assay had clinical significance for the diagnosis of IPFIs in children with non-neutropenic.Serum GM assay alone had low diagnostic value for IPA in non-neutropenic children.Properly higher cut-off level and continuous monitoring was helpful for excluding false positive.3.Parallel tests(positive result of G or GM assays appeared to be useful in improving the diagnostic value of IPFIs.Negative results suggest lower incidence of IP A,but cannot exclude IP A completely... |
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