Abstract: Objective:To analyze the clinical and imaging characteristics of invasive fungal disease (IFD) in high-risk children, and to evaluate the clinical value of serum (1,3)-β-D-glucan and galactomannan detection in children with IFD. Methods: Retrospective analysis was performed on children admitted to Children’s Hospital of Chongqing Medical University from June 2015 to June 2019, who were suspected of fungal infection and completed G test, GM test and fungal culture. According to invasive fungal disease diagnostic criteria, the study subjects were divided into IFD group and non-IFD group. The clinical characteristics of children with IFD were analyzed, and the sensitivity and specificity of the G test and the GM test for the diagnosis of IFD were calculated. Results: There were 64 patients in the IFD group with 24 of proven IFD and 40 of probable IFD. There were 100 cases in non-IFD group. Pulmonary patchy, nodules, and pleural effusions were common in the lung imaging findings in the IFD group, but there were relatively fewer cavitation and halo sign. Children with Aspergillus infection had higher incidence of halo sign and air crescent sign than those with Candida infection. In children with non-Aspergillus infection, the CT appearance of the lung was mainly patchy and nodular, with few signs of cavitation and halo sign. Sixty-four pathogenic fungi were detected in 64 children with IFD, among which Candida albicans had the highest detection rate of 42.2%, and Aspergillus was detected in 10 children (15.6%). The sensitivity and specificity of G test was 68.8% and 87.0% respectively and the sensitivity and specificity of GM test was 80.0% and 95.0% respectively. The area under the ROC curve for G test and GM test was 0.79 (95% CI：0.72~0.87) and 0.92 (95% CI：0.82~1.00), respectively. Conclusion: The clinical and imaging manifestations of IFD in children are not typical, and the typical cavitation and halo signs in lung imaging are relatively few. Patches, nodules, and pleural effusions are common. The (1,3)-β-D-glucan has a moderate value for the diagnosis of non-Aspergillus IFD in children, while the GM test has a high diagnostic value for Aspergillus IFD in children.

Key words: -D-glucan, Galactomannan, Invasive fungal disease, Children, Clinical features, (1,3)-&beta