Value of plasma beta-Glucan in early diagnosis of invasive fungal infection in children / 中国当代儿科杂志

<p><b>OBJECTIVE</b>The incidence of invasive fungal infection (IFI) has risen dramatically along with the prolongation of immunocompromised individuals' lifespan. This study aimed to investigate the incidence of IFI among high risk pediatric patients and to evaluate the diagnostic value of circulating (1,3)-beta-D-glucan (BG) in IFI.</p><p><b>METHODS</b>High risk pediatric inpatients from hemato-oncology department and ICU were enrolled from November 2007 to June 2008. All the patients had persistent fever for 4 to 7 days or longer. Circulating BG levels were detected once or twice weekly until the signs and symptoms improved, or IFI was excluded, or death. Circulating BG levels were determined by the GKT-5M Set Kinetic Fungus Detection Kit. Detection of plasma BG was judged positive when the level was > or = 10 pg/mL.</p><p><b>RESULTS</b>A total of 130 patients were enrolled. Two patients with candidemia were classified as proven IFI, 20 as probale IFI,7 as possible IFI, and 101 without IFI. The patients with proven or probable IFI had a longer length of hospital stay (P< 0.05) and an increased mortality rate (P< 0.05). The patients with IFI demonstrated a higher plasma level of BG than those without IFI (P< 0.01). The sensitivity, specificity, positive and negative predictive values for plasma BG detction were 81.8%, 82.4%, 48.6% and 95.7% respectively. Positive BG results occurred before the abnormal results on computed tomography scan or fungal culture or simultaneously in 72.2% of the cases.</p><p><b>CONCLUSIONS</b>IFI is not rare among pediatric high-risk patients. Circulating BG detection is accurate to a certain extent in the diagnosis of IFI. It is a useful adjunct means for IFI screening in high-risk patients.</p>

Overview of clinical occurrence of primary immunodeficiency disorders in children / 中华儿科杂志

<p><b>OBJECTIVE</b>More than one hundred primary immunodeficiency disorders have been discovered so far. But the incidence of these disorders in our country is still not clear, so we analyzed the clinical data of 93 children with primary immunodeficiency disorders seen in our hospital in recent 30 years to understand the occurrence of primary immunodeficiency disorders in children, to promote the clinicians to become familiar with these disorders, to improve the nationwide registry system and to establish the basis for the treatment and prevention in future.</p><p><b>METHODS</b>To analyze the constituent ratio of the 93 children with primary immunodeficiency disorders seen in our hospital from 1974 to 2003, diagnostic and classification criteria were set by taking the proposal by International Union of Immunological Societies (IUIS) PID classification committee in 2003 into account. All the data were analyzed retrospectively.</p><p><b>RESULTS</b>In the 93 children with primary immunodeficiency disorders, antibody deficiencies were the most frequent (39.8%) finding, followed by combined immunodeficiency, combined T- and B-cell disorders (22.6%), and T lymphocytic deficiencies alone (14.0%). Immunodeficiency with other major defects accounted for 12.9%, phagocytic disorders 9.7%, and complement deficiencies 1.1%. Thus, there seemed to be a tendency that the incidence increased with time. The incidence of these disorders has increased significantly as shown by 50 diagnosed cases in children with these disorders since 1996. Sixteen children died, with the highest mortality occurred with combined immunodeficiency. Seven children developed bronchiectasis. Two children suffered from persistent diarrhea while one of the two was complicated with persistent intestinal fistula. One child developed juvenile rheumatoid arthritis, another one with granulocytopenia and iridocyclitis, and the other with allergic purpura. The boys: girls ratio for all disorders was 3:1. The age of onset ranged from 10 days to 37 years of age.</p><p><b>CONCLUSIONS</b>There are vast variety of primary immunodeficiency disorders in our area and antibody deficiency is the most common abnormality. Combined immunodeficiency has early onset age and high mortality rate. With the great improvement of the diagnostic techniques, these disorders have become a group of important disorders and all the clinicians should pay great attention to these disorders.</p>