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Abstract
The present study was carried out at the National Cancer Institute, Cairo University, on bronchoalveolar lavage (BAL) samples received from sixty pediatric Cancer patients with suspected lower respiratory tract IFI in the period between January 2013 and May 2015. Patients included in the study were subjected to clinical examination, radiological and laboratory investigations. BAL samples received at microbiology laboratory were divided into 3 portions on which the following tests were performed: Direct microscopic examination, culture on blood agar, MacConkey agar and specific fungal media with identification of detected growth to the species level and antimicrobial susceptibility testing for bacterial isolates, Galactomannan antigen detection by Platelia{u2122} Aspergillus Ag Kit and pan fungal PCR Assay. Fungal DNA extraction was performed using QIAamp DNA Mini Kit, lyticase enzyme was utilized for enzymatic lysis of fungal cell wall. PCR amplification was performed utilizing the universal fungal primers ITS1 and ITS4. Detection of PCR amplified products was done by agarose gel electrophoresis. Patients were classified according to a modified approach of the revised definitions of IFI from the EORTC/MSG into: proven, probable, possible and unlikely IFI.Results: Various risk factors were associated with the development of IFI including hematological malignancies (P-value = 0.014), active disease state, Profound neutropenia <500/mm³ for more than 10 days (p-value <0.001), prolonged use of corticosteroids for > 3 weeks (p-value=0.035). Aspergillus growth was the predominant causative agent of lower respiratory tract IFI in our study. The most common isolated Aspergillus species were A. fumigatus and A. flavus, followed by A. nidulans, A. terreus and A. glaucus