Polymerase-chain-reaction-based diagnosis of viral pulmonary infections in immunocompromised children

Gili Kadmon*, Itzhak Levy, Michal Mandelboim, Elhanan Nahum, Jerry Stein, Sara Dovrat, Tommy Schonfeld

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Aim Viral pneumonia is a serious complication in immunocompromised children. Its aetiology is difficult to identify owing to the limitations of conventional microbiological tests. The aim of this study was to determine whether polymerase chain reaction (PCR) assays for respiratory viruses increase the diagnostic yield of bronchoalveolar lavage (BAL) in immunocompromised children. Methods BAL samples obtained from immunocompromised children hospitalized with pneumonia were processed for respiratory viruses by viral culture, rapid antigen test and PCR (for CMV, adenovirus, influenza, parainfluenza, herpesvirus, RSV and hMPV). Results The study group included 42 patients (mean age 7.2 ± 5.1 years) with 50 episodes of clinical pneumonia (50 BAL samples). Forty viral pathogens were identified in 30 episodes (60%). PCR increased the diagnostic rate by fourfold (75% identified by PCR alone, p < 0.0001). When viral culture and rapid antigen test were used as the gold standard, PCR was found to have high sensitivity (86-100% when assessed) and specificity (80-96%). The PCR results prompted the initiation of specific antiviral therapy and the avoidance of unnecessary antibiotic treatment in 17 (34%) episodes. Conclusion PCR-based diagnosis from BAL may increase the rate of pathogen detection in immunocompromised children, decrease the time to diagnosis and spare patients unnecessary antimicrobial treatment.

Original languageEnglish
Pages (from-to)e263-e268
JournalActa Paediatrica, International Journal of Paediatrics
Volume102
Issue number6
DOIs
StatePublished - Jun 2013
Externally publishedYes

Keywords

  • Bronchoalveolar lavage
  • Immunodeficiency
  • Pneumonia
  • Polymerase chain reaction
  • Viral infection

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