Utility of Pan-Fungal, Aspergillus, and Mucorales PCR in the Diagnostic Evaluation of Children with Suspected Pulmonary Infections

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ID: 327371
2026
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Abstract
Abstract Background The incidence of pulmonary invasive fungal infections (PIFIs) in the U.S. is increasing, especially among immunocompromised populations. Traditional diagnostics have limited sensitivity/specificity and often require invasive procedures. Fungal PCRs have the potential for increasing yield and timeliness of diagnostics. This study evaluates the role of fungal PCRs in the diagnosis of PIFIs in children. Methods This retrospective cohort includes children ≤18 years with a University of Washington Pan-fungal, Aspergillus, and/or Mucorales PCR (collectively referred to as fungal PCR) sent from bronchoalveolar lavage (BAL), pleural fluid, and/or lung tissue between 01/2020-09/2025. Demographic and clinical data were collected through EPIC chart review and recorded in REDCap. The impact of fungal PCRs, as categorized by test episodes based on shared specimen source and collection date, on antifungal regimen was evaluated. Descriptive statistics were performed, and analyses were performed using R v4.4.2. Results Overall, 132 unique subjects across 150 hospitalizations were included, with a total of 171 test episodes and 302 individual fungal PCR tests. 70% of patients were immunocompromised including 40% with cancer, 36% with a transplant history, and 18% with a primary immunodeficiency. 59% of admissions involved ICU care and 19% led to a PIFI diagnosis. Only 6% (19/302) of all fungal PCRs were positive. Pan-fungal PCR was most frequently performed; 11% (18/160) were positive (Figure 1). No Aspergillus PCRs (n=116) were positive and 4% (1/26) of Mucorales PCRs were positive. PJP and Candida were the most frequently detected infections by fungal PCRs and were always concordant with traditional testing modalities such as fluorescent antibody testing and fungal culture (Figure 1). Only 4 out of 302 PCRs (1%) were positive without a concordant conventional diagnostic test, all involving molds. Following 24% of test episodes, there was a change in antifungal regimen, of which 59% credited fungal PCRs for the change. Among immunocompromised patients, there was a change in antifungal regimen following 27% of test episodes, of which 65% credited fungal PCRs. Overall, fungal PCRs were explicitly mentioned as a reason for either continuation or change in antifungals in 19% (n=33) of episodes (Table 1). Conclusion Only a minority of fungal PCR results were positive. Fungal PCR testing contributed to changes or continuation of antifungals in approximately a fifth of cases. Among immunocompromised patients, fungal PCR testing contributed to antifungal management only marginally more often. Further analysis is needed to specify in which patients this diagnostic modality is most useful.
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Authors Irem Onalan, Surabhi Vora, Drew Bell, Zheyi Teoh
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Journal journal of the pediatric infectious diseases society
Year 2026
DOI
10.1093/jpids/piag070/piag070.081
URL
https://academic.oup.com/jpids/article-pdf/15/Supplement_2/S38/70833305/piag070.081.pdf
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