Paediatric Fungal Infections – Diagnostic Methods

A summary of diagnostic methods for detecting aspergillus infections, where no data exists for aspergillus – other fungal infections have been included.

(The following table has been compiled from the published work of Groll et al, Walsh et al, Dornbusch et al in Clinical Microbiology Infect. 16(9), 1319-53, 2010). Register to view articles.

Test Type Effective for Exclusions Problems
Galactomannan assay (Serum)
(Fungal cell wall marker)
Found in all Aspergillus species. For serum, urine, BAL*, CSF and other. Rapid diagnosis (pre–radiographic signs of infection). [1] [2] CGD , Jobs syndrome (false negatives) May be false negatives (see exclusions). Could be low sensitivity in cancer patients.
False positives with contaminating GM  in some b lactam antibiotics  esp. Amoxicillin,piperacillin-tazobactam. Also dietary GM should be considered.
Beta 1-3 glucan
(Fungal cell wall marker)
Testing is limited. Not species specific.
Minimum data in children. (Candida meningoencephalitis in CSF – may be a useful test) [3]
  Do paediatric patients have a high baseline for this Antigen?
Possible false negatives from cellulose in surgical gauze.
Need to define cut off values.
Mannan antibodies (serum) Yeast only – but may be used for exclusion purposes. [4] [5]   Preliminary neonate data encouraging.
Fungal DNA -PCR High specificity and sensitivity. Rapid [6]   Difficult to extract fungal DNA and susceptible to contamination. If using blood samples –several ml of blood required. [7]
Microscopy Practical and inexpensive Limited to site Slow – causing delay in diagnosis
Diagnostic imaging
Halo sign and later sign of air crescent less frequently seen in paediatrics.
Whereas focal bronchopneumonia more often seen. [8] [9]
  Risk of CT radiation in children is greater than adults. [10]

Important information: At no time should the information compiled here be used as a treatment protocol or for any other purpose except to provide the latest available summary of information relating to paediatric patients for educational and scientific purpose. We accept no liability for the use of data gathered here.
Treatments should always be carried out according to manufacturers instructions. Not all antifungal treatments are licensed for use in paediatric patients – please check this.

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