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Article in Japanese

Test methods and characteristics for invasive pulmonary mycosis in children

Ryu YONEDA1), Hanako FUNAKOSHI1), Sho ISHII1), Kotaro ARAKI1), Takemi MURAI1), Kahoru FUKUOKA1), Yuta AIZAWA1), Yuho HORIKOSHI1)

The diagnostic method about invasive pulmonary mycosis is challenging in that little is known about the condition in Japanese children. The aim of this study was to evaluate the methods and characteristics of diagnosis for invasive pulmonary mycosis in children. This study included a total of 15 patients with invasive pulmonary mycosis between March 2010 and March 2017. The pathogens were Aspergillus spp (n=10), Mucor (n=2), and Pneumocystis jirovecii (n=2). Proven invasive fungal diseases (IFD) diagnosed by culture from sterile material were identified in 3 patients. Probable IFDs were identified in 10 patients, and 6 of them were diagnosed by antigen tests. Among those patients with aspergillosis, 3 were diagnosed by culture. However, one of them was negative for the Galactomannan antigen, and two negative for (1→3)-β-D-glucan (BDG). Five patients were diagnosed with the Galactomannan antigen, of which three were negative for BDG. Two patients were diagnosed by polymerase chain reaction (PCR), however, both of them were negative for all fungal biomarkers. BDG over 300pg/mL demonstrated in both patients with P. jirovecii, which suggested that BDG is likely to increase considerably in P. jirovecii pneumoniae. There were some patients who had negative fungal biomarkers despite the positive result of culture or PCR. Therefore, the diagnosis of IFD should be explored comprehensively with several available tests.

1) Division of Infectious Diseases, Department of Pediatrics, Tokyo Metropolitan Children's Medical Center

Key words invasive pulmonary mycosis, invasive fungal infection, galactomannan antigen, (1→3)-β-D-glucan
Received November 27, 2017
Accepted April 3, 2018

30 (2):107─113,2018