title: Aspergillus galactomannan antigen assay and invasive aspergillosis in pediatric cancer patients and hematopoietic stem cell transplant recipients.
abstract: BACKGROUND
  Invasive aspergillosis (IA) is a major cause of morbidity and mortality in immunocompromised children. We investigated the usefulness of an Aspergillus galactomannan (GM) antigen assay as a diagnostic tool for IA in pediatric cancer patients and hematopoietic cell transplantation (HCT) recipients.
  
  
  METHODS
  The GM antigen assay results were analyzed in 749 blood samples from 99 patients. A GM index (GMI) greater than or equal to 0.5 on at least two separate occasions was considered positive. A review of the clinical data was performed for subjects with proven or probable IA.
  
  
  RESULTS
  Twenty-one of 23 patients with proven or probable IA had positive GM antigen test results (91.3% sensitivity, 95% CI 71.9-98.9; 81.7% specificity, 95% CI 69.6-90.5; P < 0.0001). The false-positive rate was 18.3%. Being younger than 3 years of age, having a solid tumor, and receiving HCT within 4 weeks of the test were statistically significant factors for causing false-positive results (P < 0.05). Among the 23 patients with IA (six proven, 17 probable), 16 (69.6%) had hematological malignancies, five (22.7%) had solid tumors, and two (8.7%) had primary immunodeficiency. Nineteen patients (82.6%) received HCT. The most common clinical site of IA was the lungs (91.3%), and consolidation was the most frequent finding in chest CT scans (36.8%). The mortality at 12 weeks was 43.5%.
  
  
  CONCLUSIONS
  Having a positive GM assay at least twice is useful in diagnosing IA in pediatric patients with cancer and HCT recipients.
authors.affiliation: Department of Pediatrics, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea.
authors.forename: Soo-Han
authors.initials: SH
authors.lastname: Choi
authors.forename: Eun-Suk
authors.initials: ES
authors.lastname: Kang
authors.forename: Hong
authors.initials: H
authors.lastname: Eo
authors.forename: So-Young
authors.initials: SY
authors.lastname: Yoo
authors.forename: Ji Hye
authors.initials: JH
authors.lastname: Kim
authors.forename: Keon Hee
authors.initials: KH
authors.lastname: Yoo
authors.forename: Ki Woong
authors.initials: KW
authors.lastname: Sung
authors.forename: Hong Hoe
authors.initials: HH
authors.lastname: Koo
authors.forename: Yae-Jean
authors.initials: YJ
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D000946:Antigens, Fungal / Q000032:analysis*; D001228:Aspergillosis / Q000175:diagnosis*; D002648:Child; D002675:Child, Preschool; D005189:False Positive Reactions; D005260:Female; D005690:Galactose / Q000031:analogs & derivatives; D019337:Hematologic Neoplasms / Q000150:complications* / Q000382:microbiology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007124:Immunoenzyme Techniques / Q000379:methods*; D007223:Infant; D008297:Male; D008351:Mannans / Q000032:analysis*; D012680:Sensitivity and Specificity
chemical_list: D000946:Antigens, Fungal; D008351:Mannans; C012990:galactomannan; D005690:Galactose