Clark John Alexander, Gouliouris Theodore, Conway Morris Andrew, Curran Martin D, White Deborah, Daubney Esther, Navapurkar Vilas, Baker Stephen, Pathan Nazima
Department of Paediatrics, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, UK.
Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
Transl Pediatr. 2024 Apr 30;13(4):697-703. doi: 10.21037/tp-23-525. Epub 2024 Apr 11.
A microbiological cause of infection is infrequently identified in critically unwell children with a respiratory infection. Molecular diagnostic arrays provide an alternative. These tests are becoming more broadly available, but little is known about how clinicians interpret the results to impact clinical decision making.
Here we describe three cases of bacterial and fungal lower respiratory tract infection (LRTI) diagnosed in the paediatric intensive care unit (PICU) using a custom 52 respiratory pathogen TaqMan array card (TAC). Firstly, an early diagnosis of pneumonia was made with the support of the TAC in a trauma patient who received prolonged mechanical ventilation. The pathogen was only identified on microbiological cultures after further clinical deterioration had occurred. Secondly, a rare case of psittacosis was identified in an adolescent with acute respiratory distress, initially suspected to have multisystem inflammatory syndrome in children (MIS-C). Finally, pneumonia was identified in an infant with recurrent apnoeas, initially treated for meningitis. Two diagnoses would not have been established using commercially available arrays, and pathogen-specific diagnoses were established faster than that of routine microbiological culture.
The pathogens included on molecular arrays and interpretation by a multidisciplinary team are crucial in providing value to PICU diagnostic services. Molecular arrays have the potential to enhance early pathogen-specific diagnosis of LRTI in the PICU.
在患有呼吸道感染的危重症儿童中，感染的微生物病因很少能被确定。分子诊断阵列提供了一种替代方法。这些检测方法越来越广泛地可用，但对于临床医生如何解读结果以影响临床决策知之甚少。
在此，我们描述了三例在儿科重症监护病房（PICU）中使用定制的52种呼吸道病原体TaqMan阵列卡（TAC）诊断出的细菌和真菌性下呼吸道感染（LRTI）病例。首先，在一名接受长时间机械通气的创伤患者中，TAC辅助早期诊断出肺炎。在病情进一步恶化后，病原体才在微生物培养中被鉴定出来。其次，在一名患有急性呼吸窘迫的青少年中发现了一例罕见的鹦鹉热病例，该患者最初被怀疑患有儿童多系统炎症综合征（MIS-C）。最后，在一名反复出现呼吸暂停的婴儿中诊断出肺炎，该婴儿最初接受的是脑膜炎治疗。使用市售阵列无法做出这两项诊断，并且病原体特异性诊断的建立比常规微生物培养更快。
分子阵列所包含的病原体以及多学科团队的解读对于为PICU诊断服务提供价值至关重要。分子阵列有潜力加强PICU中LRTI的早期病原体特异性诊断。
