Abstract
Effective management of invasive aspergillosis (IA) requires early and accurate diagnosis. Microscopy and culture of appropriate specimens remain the gold standard of mycological diagnosis. High-resolution computed tomography serially performed constitutes a sensitive mode of diagnosis of pulmonary IA in hematological patients, but similar data is lacking for children. While early diagnosis of IA has been improved with galactomannan assay in adults, its use is problematic in young infants due to specificity inferiority. Galactomannan testing also is characterized by low sensitivity in pediatric patients with primary immunodeficiencies including chronic granulomatous disease and Job's syndrome. Beta-D glucan assay has been studied in adult patients with fungal infections including IA. The high negative predictive value of the assay allows its use for excluding IA; no specific data, however, exist for children. Polymerase chain reaction (PCR) may be a powerful tool for early diagnosis of IA but has not been standardized for routine use yet. No studies address the issue in neonates, whereas in children PCR has not been specifically studied but is probably as good as in adults. A high degree of suspicion in immunodeficient pediatric hosts, suggestive clinical and radiological findings, as well as mycological data by application of multiple diagnostic methods including serology and molecular biology, are expected to enhance the capacity to diagnose IA in young patients.