الفهرس 
The Immunocompromised HostOnly 14 pages are availabe for public view
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Abstract
This study was conducted on 30 patients diagnosed as having immunodeficiency (either 1ry or 2ry) and were suspected to have fungal infection. They were randomly recruited from the Pediatric Allergy and Immunology Unit, the Pediatric Hematology and Oncology and the Intensive Care Units of Ain Shams University, Children′s Hospital. They were 9 females and 21 males with ages ranging from 3 months to 14 years, and the study extended from March 2009 to April 2010. They were classified into two groups:
A: Group of primary immunodeficiency included 9 patients (30%)
B: Group of secondary immunodeficiency included 21 patients (70%). All patients included in this group were on chemotherapy.
All patients were subjected to history taking, clinical examination, and the following investigations:
• Complete blood count with differential count
• C reactive protein
• Erythrocyte sedimentation rate
• Blood culture for fungus
• Pan-fungal PCR
• PCR for Aspergillus to PCR +ve patients.
The study revealed that culture was negative to bacteria and fungi in 25 patients (83.3%), positive for Candida in 2 patients (6.7%) and positive for bacteria in 3 patients (9.9%).
Blood culture for fungi had a sensitivity of 12% (2/17) and specificity of 100% (13/13) with a positive predictive value (PPV) of 100% and a negative predictive value (NPV) of 46% with diagnostic accuracy of 50%.
Panfungal PCR detected 17 patients (56.7%) with fungal infections and 15 of them (88.2%) were missed by blood culture. All patients with a positive fungal culture were also positive by PCR.
There was no significant variation in mean age, gender type, degree of fever, type of immunodeficiency whether primary or secondary, clinical presentation, CBC, ESR and current intake of antifungal treatment with the results of PCR (P>0.05), (PCR was positive in 14 patients treated with antifungal therapy for 1-14 days). However, there was a significant correlation between high CRP levels and fungemia as detected by pan-fungal PCR.
In our study Candida was detected in 11 patients, 9/30 (30%) were detected by PCR and were missed by blood culture, while Aspergillus was detected in 6/30 patients (20%) by Aspergillus PCR when all the blood cultures were negative to Aspergillus.
As a conclusion, panfungal PCR had detected the presence of fungal infection which was missed by blood culture, and this illustrates the potential benefit of using panfungal PCR for early diagnosis of fungal infection in immunocompromised patients.