Multiplex PCR for Pathogen Identification among Otherwise Healthy Children Presenting with AcuteLife-threatening Infection
Keywords:
Sepsis, Septic shock, Pneumonia, Respiratory failure, Multiplex polymerase chain reactionAbstract
Background : Diagnostic yield of conventional, culture-based method of pathogen detection among sepsis and severe pneumonia is generally disappointedly low.
Objectives : To determine the etiological organisms causing community-acquired life-threatening infections (CA-LTI) among previously healthy children using multiplex polymerase chain reaction (mPCR).
Methods : A prospective descriptive survey was conducted among all children aged 1 month -15 years diagnosed with community-acquired sepsis with septic shock and pneumonia with respiratory failure. Serum and/or tracheal aspirates for pathogen identification using mPCR targeting 33 common pathogens were obtained from all subjects.
Results : A total of 79 cases were enrolled: n = 17 for sepsis (21.5%) and n = 62 for pneumonia (78.5%). Nine cases (11.4%) had one pathogen identified in serum sample using mPCR: n = 4 (23.5%) for sepsis and n=5 (8%) for pneumonia cases. Among sepsis cases, the pathogens identified in serum via mPCR were rhinovirus and bocavirus, (n=2 each). One pathogen identified by conventional blood culture was Entercoccus faecalis. Among pneumonia cases, 8% (n=5) had at least one potential pathogen identified in serum by mPCR with bocavirus and H. influenzae being the most common (n= 2 each). Similarly, H. influenzae were the most commonly identified by mPCR in tracheal aspirates (n=10). The fatality rates were 5.9% among sepsis and 1.6% among pneumonia cases.
Conclusions : Viruses are among the important causes of CA-LTI in previously healthy children. Using mPCR enables 9-fold increase in the proportion of pathogen identification in serum in children with septic shock and severe pneumonia.
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