Diagnostic Bronchoalveolar Lavage (BAL) for Pulmonary Fungal Infections in Critically III Children

摘要

Introduction: The incidence of pulmonary fungal infection (PFI) is increasing worldwide, particularly in critically ill patients. The aim was to assess, using bronchoscopic bronchoalveolar lavage (BAL), specimens for the diagnosis of clinically and radiologi-cally suspected PFIs in critically ill children.Materials: Thirty-five children, admitted to the Pediatric Intensive Care Unit because of their critical illness, were included. All children underwent full medical history evaluation and thorough clinical examination; basic laboratory investigations (from which the pediatric risk of mortality critical illness score was calculated) and chest imaging were carried out. Bronchoscopic BAL fluid and blood were cultured on Sabour-aud Dextrose Agar. Fungal antigen-detection tests using the enzyme-linked immunosorbent assay, for both Aspergillus galactomannan antigen and Candida mannan antigen, were also carried out.Results: PFI was defined as probable in 77% of the studied children. BAL investigations provedto have a higher diagnostic yield (P < 0.001) compared with blood. Positive fungal antigens in BAL fluid were significantly higher than positive BAL fungal cultures in the studied children (P < 0.001). Risk-factor analyses for fungal infection among the studied patients revealed that prolonged Pediatric Intensive Care Unit stay ( > 1 wk) (odds ratio = 24; 95% confidence interval: 2.14-650, P = 0.002) and high pediatric risk of mortality (cutoff value 35; P < 0.001) were significant risk factors for probable fungal infection.Conclusions: BAL fluid sampling is a safe, technically simple procedure and has a significant diagnostic value for pediatric PFIs, especially if assessed with both fungal cultures and antigen fungal detections.