| Cohort | Since 2012, all patients from the University Children’s Hospital Würzburg were screened twice weekly by GM ELISA and PCR-based diagnostic assays. In July 2015, all patients to date (n = 39) were selected for retrospective data analysis. All patients (24 males, median age of 9.5 years [range, 4 to 21 years]; 15 females, median age of 10 years [3 to 19 years]) had alloHSCT. Patients were diagnosed with the following underlying diseases: acute lymphoblastic leukemia (n = 22), myelodysplastic syndrome (n = 5), acute myeloid leukemia (n = 3), and other diseases, including chronic myeloid leukemia, Hodgkin lymphoma, Diamond-Blackfan anemia, thalassemia, neuroblastoma, Fanconi anemia, adrenoleukodystrophy, severe aplastic anemia, and Omenn syndrome (n = 1 each). In this cohort, 85% of the patients received one or two mold-active antifungal drugs as prophylaxis or empirical therapy prior to commencing or during diagnostic testing (among them, 97%, 13%, 13%, and 17% received liposomal amphotericin B, voriconazole, posaconazole, and caspofungin, respectively). The durations of antifungal prophylaxis and empirical therapy were 27 ± 28 days, 35 ± 33 days, and 99 ± 84 days (mean ± SD) in patients with unclassified, possible, and probable disease, respectively. In total, 543 blood samples (mean, 13.9 samples per patient; range, 6 to 33 samples) were collected. Sampling started in the preparative phase for alloHSCT (median, 14 days [range, 0 to 74 days] before transplantation) and continued for all patients until day + 100 after alloHSCT or, if before day + 100, until the patient died. |
| Disease Introduction Mechanism | Invasive aspergillosis (IA) is the most significant opportunistic fungal infection in neutropenic adult and pediatric patients following allogeneic hematopoietic stem cell transplantation (alloHSCT). Diagnosis of IA is challenging, as clinical symptoms are often nonspecific and classical diagnosis is poor. Methods such as highresolution computed tomography (CT) scans show only typical signs once the infection is established, and even then specific signs can be transient. Serological tests that detect galactomannan (GM) and _-D-glucan have low positive predictive values (PPVs), better used for the exclusion rather than the diagnosis of IA. |
