title: Diagnostic potential of nested PCR, galactomannan EIA, and beta-D-glucan for invasive aspergillosis in pediatric patients.
abstract: BACKGROUND
  Limited specific data and investigations are available for invasive aspergillosis (IA) in pediatric patients. We evaluated the diagnostic potential of three noninvasive tests including the Platelia Aspergillus EIA kit for using galactomannan antigen, (1,3)-β-D-glucan Detection Reagent Kit, and nested-PCR for Aspergillus DNA in sera. We evaluated the diagnostic potential of three noninvasive tests including EIA for galactomannan antigen  (Platelia Aspergillus), nested  PCR assay for Aspergillus DNA and test for (1→3)-β-D-glucan (Glucatell assay Kit).
  
  
  METHODS
  All pediatric patients treated at the hematology/oncology unit who were at increased risk of developing invasive aspergillosis were enrolled. Clinical samples were examined for Aspergillus infections by mycological methods. Serial blood samples were collected twice weekly and evaluated by noninvasive tests.
  
  
  RESULTS
  We analyzed 230 consecutive blood samples from 62 pediatric patients. The incidence rate of invasive aspergillosis in the patients was found to be 27.4%, and the etiologic agents were Aspergillus flavus, Aspergillus fumigatus, and Aspergillus spp.  The sensitivity, specificity, positive and negative predictive values, and likelihood ratios for positive and negative results of galactomannan in patients with proven and probable IA were 90%, 92%, 81.8%, 96%, 11.25, and 0.1; for beta-D-glucan they were 50%, 46%, 26%, 70.6%, 0.9, 0.9; and for nested-PCR they were 80%, 96.2%, 88.9%, 92.6%, 21, and 0.2, respectively.
  
  
  CONCLUSIONS
  The conventional methods are not able to detect IA, due to the lack of valid and proper sampling. Galactomannan and nested-PCR tests in serum, with enough accuracy and reliability, can serve as noninvasive methods for the detection of IA in pediatric patients. However, the beta-D-glucan test cannot serve as an efficient diagnostic tool in those with hematologic disorders.
authors.affiliation: Prof. Alborzi Clinical Microbiology Research Center, Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran. badieep@yahoo.com
authors.forename: Parisa
authors.initials: P
authors.lastname: Badiee
authors.forename: Abdolvahab
authors.initials: A
authors.lastname: Alborzi
authors.forename: Mahammad
authors.initials: M
authors.lastname: Karimi
authors.forename: Bahman
authors.initials: B
authors.lastname: Pourabbas
authors.forename: Pedram
authors.initials: P
authors.lastname: Haddadi
authors.forename: Jalal
authors.initials: J
authors.lastname: Mardaneh
authors.forename: Mahsa
authors.initials: M
authors.lastname: Moieni
mesh_terms: D000293:Adolescent; D001230:Aspergillus / Q000737:chemistry / Q000235:genetics / Q000302:isolation & purification*; D002648:Child; D002675:Child, Preschool; D019411:Clinical Laboratory Techniques / Q000379:methods*; D005260:Female; D005690:Galactose / Q000031:analogs & derivatives; D006801:Humans; D007124:Immunoenzyme Techniques / Q000379:methods*; D007223:Infant; D055744:Invasive Pulmonary Aspergillosis / Q000175:diagnosis* / Q000382:microbiology; D008297:Male; D008351:Mannans / Q000032:analysis; D016133:Polymerase Chain Reaction / Q000379:methods*; D011509:Proteoglycans; D011933:Reagent Kits, Diagnostic; D047071:beta-Glucans / Q000032:analysis
chemical_list: D008351:Mannans; D011509:Proteoglycans; D011933:Reagent Kits, Diagnostic; D047071:beta-Glucans; C012990:galactomannan; C010770:polysaccharide-K; D005690:Galactose