1062. Aspergillus Galactomannan Antigen Assay in Pediatric Cancer Patients with Invasive Aspergillosis: A Single Center Experience during Recent 3-years 
Session: Poster Abstract Session: Healthcare-Associated Infections in Children
Saturday, October 22, 2011
Room: Poster Hall B1
Background: Invasive aspergillosis (IA) is a major cause of morbidity and mortality in immunocompromised children. We investigated the usefulness of Aspergillus galactomannan (GM) antigen assay as a diagnostic tool for IA in pediatric cancer patients and hematopoietic cell transplantation (HCT) recipients.

Methods: GM antigen assay results were analysed in 902 blood samples from 180 pediatric cancer patients at Samsung Medical Center, Seoul, Korea from July 2007 to September 2010. Blood samples with GM index ≥0.5 at least twice in a patient were considered positive. A review of clinical data was performed on subjects with proven or probable IA defined by the European Organization for Research and Treatment of Cancer-Mycoses Study Group criteria (EORTC/MSG).

Results: Twenty-one of 23 patients with proven or probable IA had positive GM antigen test results (91.3% sensitivity, 95% confidence interval (CI) 0.7194-0.9893; 81.7% specificity, 95% CI 0.6958-0.9048; P< 0.0001). False positive rate was 18.3% (11/60); the patient age (<3 year), having solid tumor and receiving HCT within 4 weeks were statistically significant factors for false positive result (P < 0.05). Among 23 patients with IA (six with proven IA and 17 with probable IA), 16 had hematological malignancies (69.6%), 5 had solid tumors (21.7%) and 2 had primary immune deficiency (8.7%). Nineteen patients (82.6%) received HCT (16 allogeneic and 3 autologous). Most patients had several immunocompromised risk factors; steroid therapy (12, 52.2%), immunosuppressive therapy (16, 69.6%) and GVHD (13, 56.5%). The most common clinical site of IA was the lungs (21, 91.3%) and consolidation was the most frequent finding on chest CT (11, 37.9%). Before the diagnosis of IA, 60.9% of patients received antifungal agents (itraconazole 57.1%, fluconazole 42.9%). Amphotericin B deoxycholate was given as the first choice for antifungal agent (15, 65.2%). Six patients received more than two antifungal agents concurrently. The overall mortality was 56.5% and IA attributable mortality was 43.5% despite aggressive antifungal managements.

Conclusion: The GM antigen assay appears to be useful to diagnose IA in pediatric cancer patients and clinical correlation is imperative.


Subject Category: P. Pediatric and perinatal infections

Soo-Han Choi, MD1, Eun-Suk Kang, MD2, Soo-Hyun Lee, MD1, Keon-Hee Yoo, MD1, Ki-Woong Sung, MD1, Hong-Hoe Koo, MD1 and Yae-Jean Kim, MD1, (1)Department of Pediatrics, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, South Korea, (2)Department of Laboratory Medicine, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, South Korea

Disclosures:

S. H. Choi, None

E. S. Kang, None

S. H. Lee, None

K. H. Yoo, None

K. W. Sung, None

H. H. Koo, None

Y. J. Kim, None

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