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ORIGINAL ARTICLE
Year : 2017  |  Volume : 42  |  Issue : 4  |  Page : 142-147

Diagnosis of fungemia among pediatric patients with hematological malignancies: value of panfungal polymerase chain reaction


1 Department of Clinical Pathology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
2 Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt

Correspondence Address:
Marwa A El-Ashry
Department of Clinical Pathology, Faculty of Medicine, Ain Shams University, Cairo
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ejh.ejh_41_17

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Introduction Invasive fungal infections (IFIs) remain a significant threat to pediatric patients with hematological malignancies and to those undergoing stem cell transplantation. IFIs not only increase mortality and morbidity but may also lead to delayed administration of chemotherapy, prolonged hospitalization, and additional costs associated with antifungal therapy. Early detection and appropriate treatment is crucial for the survival of these patients. Aim The aim was to determine the value of real-time (RT) PCR, using a panfungal marker, in screening pediatric patients with hematological malignancies for early detection of IFIs. Patients and methods This study included 50 children previously diagnosed with different hematological malignancies and admitted to the Pediatric Hematology, Oncology and Intensive Care Units of Ain Shams University Children Hospital for treatment and follow-up. Children were clinically suspected as having an IFI. There were 20 (40%) females and 30 (60%) males, with their ages ranging from 2 to 18 years (median: 6; interquartile range: 4–10.25). Venous blood was collected from all patients and was submitted for the diagnosis of IFI by conventional blood culture and RT-PCR assay using universal fungal primers for amplification of the internal transcribed spacer 1 and internal transcribed spacer 4 regions. Results Of the 50 studied cases, 40% were positive for IFI by both blood culture and the panfungal PCR. A total of 12 (24%) patients were positive by the panfungal PCR only and the remaining 36% were negative by both assays. There was a statistically moderate agreement between the results of blood culture and that of RT-PCR for the detection of the panfungal marker (κ=0.545). Conclusion RT-PCR assay, using the panfungal marker, is a rapid and sensitive assay that can be reliably used for screening hematological malignant patients at high risk of IFIs. The negative predictive value of the assay is 100%; thus, it can provide greater confidence in excluding a diagnosis of IFIs when negative results are obtained. This, in turn, can help prevent unnecessary toxicity resulting from empirical antifungal treatment in individuals who may not be at risk of imminent fungal disease. However, the RT-PCR for the detection of the panfungal marker lacks specificity, making the interpretation of positive results a challenge.


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