DIAGNOSTIC BRONCHOALVEOLAR LAVAGE FOR PULMONARY FUNGAL INFECTIONS IN CRITICALLY ILL CHILDREN

Abstract

INTRODUCTION: The incidence of pulmonary fungal infection is increasing worldwide, particularly in critically ill patients. OBJECTIVE: The objective of this study was to assess bronchoalveolar lavage (BAL) as a diagnostic specimen for clinically and radiologically suspected fungal pneumonia in critically ill children. METHODS: Thirty-five children who were admitted to the PICU of Ain Shams University because of their critical illness were included. All children underwent full medical history; thorough clinical examination, including general and local chest examination and basic laboratory investigations (from that, the Pediatric Risk of Mortality [PRISM] score was calculated to evaluate the critical illness severity); chest imaging; and bronchoscopic collection of BAL and microbiological assessment of BAL and blood using direct microscopic examination, cultured on Sabouraud dextrose agar, and fungal antigen detection using the enzyme-linked immunosorbent test for both Aspergillus galactomannan antigen and Candida mannan antigen. RESULTS: Pulmonary fungal infection was documented in 77% of the studied children. BAL investigations proved to have a higher diagnostic yield in comparison with blood. Positive fungal antigens in BAL fluid were significantly higher than positive BAL fungal cultures in studied children. Analysis of the risk factors for fungal infection among the studied patients revealed that prolonged PICU stay (≥1 week) and high PRISM score (mean: 35.9 ± 6.46) were significant risk factors for fungal infection. CONCLUSIONS: BAL fluid investigation has a significantly higher diagnostic value for pulmonary fungal infections than that of the blood. The results may be further improved especially if both culture and antigen fungal detections are combined.