title: Non-Invasive Methods to Diagnose Fungal Infections in Pediatric Patients with Hematologic Disorders.
abstract: BACKGROUND
  Invasive fungal infection (IFIs) is a major infectious complication in immunocompromised patients. Early diagnosis and initiation of antifungal therapy is important to achieve the best outcome.
  
  
  OBJECTIVE
  The current study aimed to investigate the incidence of IFIs and evaluate the diagnostic performance of non-invasive laboratory tests: serologic (β-D-glucan, galactomannan) and molecular (nested polymerase chain reaction) tests to diagnose fungal infections in hematologic pediatric patients.
  
  
  METHODS
  In a cross-sectional study from October 2014 to January 2015, 321 blood samples of 62 pediatric patients with hematologic disorders and at high risk for fungal infections were analyzed. Non-invasive tests including the PlateliaAspergillusenzyme immunoassay (EIA) to detect galactomannan antigen, Glucatell for β-D-glucan and nested PCR to detectCandidaandAspergillusspecies-specific DNA were used in a weekly screening strategy.
  
  
  RESULTS
  Twenty six patients (42%) were considered as proven and probable IFIs, including 3 (5%) proven and 23 (37%) probable cases. Eighteen patients (29%) were considered as possible cases. The sensitivity, specificity, positive and negative predictive values for galactomannan test in 26 patients with proven and probable fungal infections were 94.4%, 100%, 100% and 94.7%; for β-D-glucan test 92.3%, 77.7%, 85%, 87.5% and for nested-PCR were 84.6%, 88.8%, 91.7% and 80%, respectively.
  
  
  CONCLUSIONS
  The rate of IFIs in pediatric patients with hematologic disorders is high, and sample collection from the sterile sites cannot be performed in immunocompromised patients. Detection of circulating fungal cell wall components and DNA in the blood using non-invasive methods can offer diagnostic help in patients with suspected IFIs. Their results should be interpreted in combination with clinical, radiological and microbiological findings.
authors.affiliation: Prof Alborzi Clinical Microbiology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Parisa
authors.initials: P
authors.lastname: Badiee
authors.affiliation: Prof Alborzi Clinical Microbiology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Zahra
authors.initials: Z
authors.lastname: Hashemizadeh
authors.affiliation: Hematology Research Center, Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Mani
authors.initials: M
authors.lastname: Ramzi
authors.affiliation: Prof Alborzi Clinical Microbiology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Karimi
authors.affiliation: Department of Medical Parasitology and Mycology, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Rasoul
authors.initials: R
authors.lastname: Mohammadi
keywords: Galactomannan; Invasive Fungal Infections; Nested-PCR; Pediatric Patients with Hematologic Disorders; β-D-Glucan