title: (1→3)-β-d-Glucan in Cerebrospinal Fluid as a Biomarker for Candida and Aspergillus Infections of the Central Nervous System in Pediatric Patients.
abstract: BACKGROUND
  Fungal infections of the central nervous system (FICNS) are important causes of morbidity and mortality among immunocompromised pediatric patients. Standard diagnostic modalities lack the sensitivity for detecting and therapeutically monitoring these life-threatening diseases. Current molecular methods remain investigational. (1→3)-β-d-glucan (BDG) is a cell wall component found in several fungal pathogens, including Candida and Aspergillus spp. Detecting BDG in cerebrospinal fluid (CSF) may be an important approach for detecting and therapeutically monitoring FICNS. To date, there has been no study that has investigated the effectiveness of CSF BDG as a diagnostic and therapeutic marker of FICNS in children.
  
  
  METHODS
  Serial BDG levels were measured in serum and CSF samples obtained from pediatric patients (aged 0-18 years) with a diagnosis of probable or proven Candida or Aspergillus CNS infection.
  
  
  RESULTS
  Nine cases of FICNS were identified in patients aged 1 month to 18 years. Two patients were infected with an Aspergillus species, and 7 patients were infected with a Candida species. All the patients at baseline had detectable BDG in their CSF. Among 7 patients who completed therapy for an FICNS, all elevated CSF BDG levels decreased to <31 pg/mL. At the time of this writing, 1 patient was still receiving therapy and continued to have elevated BDG levels. One patient died from overwhelming disseminated candidiasis. The lengths of therapy for these 9 children ranged from 2 weeks to 28 months.
  
  
  CONCLUSIONS
  The BDG assay is useful in diagnosing and therapeutically monitoring Candida and Aspergillus CNS infections in pediatric patients.
authors.affiliation: Division of Pediatrics Infectious Diseases, Department of Pediatrics, New York-Presbyterian Hospital, Weill Cornell Medical College, New York.
authors.forename: Christine M
authors.initials: CM
authors.lastname: Salvatore
authors.affiliation: Department of Pediatrics, University of California Irvine School of Medicine, Miller Children's and Women's Hospital Long Beach.
authors.forename: Tempe K
authors.initials: TK
authors.lastname: Chen
authors.affiliation: Division of Pediatrics Infectious Diseases, Department of Pediatrics, New York-Presbyterian Hospital, Weill Cornell Medical College, New York.
authors.forename: Sima S
authors.initials: SS
authors.lastname: Toussi
authors.affiliation: Division of Pediatrics Infectious Diseases, Department of Pediatrics, New York-Presbyterian Hospital, Weill Cornell Medical College, New York.
authors.forename: Patricia
authors.initials: P
authors.lastname: DeLaMora
authors.affiliation: Transplantation-Oncology Infectious Diseases Program, Division of Infectious Diseases, Department of Medicine, Weill Cornell Medical Center of Cornell University, New York.
authors.forename: Ruta
authors.initials: R
authors.lastname: Petraitiene
authors.affiliation: Associates of Cape Cod, Inc., East Falmouth, Massachusetts.
authors.forename: Malcolm A
authors.initials: MA
authors.lastname: Finkelman
authors.affiliation: Transplantation-Oncology Infectious Diseases Program, Division of Infectious Diseases, Department of Medicine, Weill Cornell Medical Center of Cornell University, New York Department of Microbiology and Immunology, Weill Cornell Medical Center of Cornell University, New York.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Walsh
mesh_terms: D001228:Aspergillosis / Q000175:diagnosis*; D015415:Biomarkers; D002175:Candida; D002177:Candidiasis / Q000175:diagnosis*; D020314:Central Nervous System Fungal Infections / Q000175:diagnosis*; D002648:Child; D006801:Humans; D009420:Nervous System; D011509:Proteoglycans; D047071:beta-Glucans / Q000134:cerebrospinal fluid*
chemical_list: D015415:Biomarkers; D011509:Proteoglycans; D047071:beta-Glucans; C010770:polysaccharide-K
keywords: (1→3)-β-d-glucan; central nervous system; children; fungal infection