Pediatric Intensive Care Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.
Pediatr Pulmonol. 2012 Oct;47(10):994-1000. doi: 10.1002/ppul.22523. Epub 2012 Feb 10.
Fungal pneumonia is a serious complication in immunocompromised children. It is difficult to diagnose because of the low sensitivity of clinical and standard laboratory tests. The aim of this study was to investigate the diagnostic impact of polymerase chain reaction (PCR) assays for fungal pathogens in bronchoalveolar lavage (BAL) fluid.
BAL samples obtained from hospitalized immunocompromised patients with clinical pneumonia between January 2007 and June 2009 were processed for microscopy and cultures in addition to PCR-based fungal assays. The results were compared between the standard and PCR methods.
Seventy-seven children with 100 episodes of pneumonia were included in the study. Fungal pathogens were detected by standard microbiological investigations in 10 episodes (10%) and by PCR-based assays alone in 20 episodes (20%). There was no significant difference in clinical improvement or mortality rate between patients diagnosed by the different methods. In 61 episodes, no fungal pathogen was identified by either method. Prolonged antifungal therapy was avoided in 43 episodes.
PCR-based assay for the diagnosis of fungal pulmonary infections may be a useful adjunct to clinical and standard microbiological techniques. The use of PCR may decrease the time to diagnosis, increase the rate of detection of fungal pathogens, and spare patients unnecessary antifungal treatment.
真菌性肺炎是免疫功能低下儿童的一种严重并发症。由于临床和标准实验室检测的敏感性较低，因此难以诊断。本研究旨在探讨聚合酶链反应（PCR）检测在支气管肺泡灌洗液（BAL）中真菌病原体中的诊断价值。
对 2007 年 1 月至 2009 年 6 月期间住院的患有临床肺炎的免疫功能低下患者的 BAL 样本进行了显微镜检查和培养，此外还进行了基于 PCR 的真菌检测。将标准方法和 PCR 方法的结果进行了比较。
本研究共纳入 77 例 100 例肺炎患儿。标准微生物学调查在 10 例（10%）和基于 PCR 的检测在 20 例（20%）中检测到真菌病原体。不同方法诊断的患者在临床改善或死亡率方面无显著差异。在 61 例中，两种方法均未鉴定出真菌病原体。在 43 例中避免了延长抗真菌治疗。
基于 PCR 的真菌性肺部感染诊断方法可能是临床和标准微生物学技术的有用补充。PCR 的应用可以缩短诊断时间，提高真菌病原体的检出率，并使患者免受不必要的抗真菌治疗。
