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

Authors

  • Gili Kadmon,

    Corresponding author
    1. Pediatric Intensive Care Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
    • Correspondence

      Gili Kadmon, M.D., Pediatric Intensive Care Unit, Schneider Children's Medical Center of Israel, Petach Tikva 49202, Israel. Tel: 972-3-9253686 | Fax: 972-3-9223924 | Email: gilikd@gmail.com

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  • Itzhak Levy,

    1. Infectious Diseases Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
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  • Michal Mandelboim,

    1. Sackler Faculty of Medicine, Central Virology Laboratory, Ministry of Health, Chaim Sheba Medical Center, Tel Aviv University, Tel Hashomer, Tel Aviv, Israel
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  • Elhanan Nahum,

    1. Pediatric Intensive Care Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
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  • Jerry Stein,

    1. Department of Hematology-Oncology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
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  • Sara Dovrat,

    1. Sackler Faculty of Medicine, Central Virology Laboratory, Ministry of Health, Chaim Sheba Medical Center, Tel Aviv University, Tel Hashomer, Tel Aviv, Israel
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  • Tommy Schonfeld

    1. Pediatric Intensive Care Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
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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.

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