Hande YETİŞGİN, Salih UYTUN, Murat Yasin GENÇOĞLU, Şule Selin Akyan SOYDAŞ, Satı Özkan TABAKÇI, Işıl BİLGİÇ, Meltem Kürtül ÇAKAR, Gamze Akca DİNÇ, Ayyüce ÜNLÜ, Bahar Ece TOKDEMİR, Çelebi YILDIRIM, Gökçen Dilşa TUĞCU, Dilber Ademhan TURAL, Sanem Eryılmaz POLAT, Güzin CİNEL
Türkiye Çocuk Hastalıkları Dergisi - 2026;20(4):221-225
Objective: Bronchoalveolar lavage (BAL) is a widely used diagnostic tool for evaluating lower respiratory tract infections and pulmonary pathologies in children. BAL provides valuable diagnostic information and can significantly influence management strategies, particularly in patients with malignancy, immunodeficiency (ID), or critical illness. This study aimed to assess the diagnostic and therapeutic value of BAL in pulmonary fungal infections. Material and Methods: This retrospective study analyzed BAL samples obtained by flexible fiberoptic bronchoscopy (FFB) between 2019 and 2024 in the Pediatric Pulmonology Department of a tertiary referral center. Among 668 patients who underwent FFB, those with BAL fungal culture, BAL Aspergillus DNA PCR, and BAL galactomannan antigen (GM) testing were included. Demographic, clinical, radiological, and bronchoscopic findings, as well as antifungal treatment modifications based on BAL results, were evaluated. Results: BAL results from 668 patients were reviewed. Fungal culture was performed in 236 (35.3%), Aspergillus DNA PCR in 127 (19%), and GM in 121 (18.1%) patients. Among those tested for fungal culture, 58.9% were male, with a mean age of 7.0 years (+/-5.7). Fungal culture positivity was found in 26 (11%) patients: Candida albicans (n=14), Aspergillus spp. (n=5), Candida dubliniensis (n=3), Aspergillus fumigatus (n=3), and Penicillium spp. (n=1). Culture positivity was significantly higher in patients with malignancy (p=0.011). BAL Aspergillus DNA PCR was positive in two patients, and BAL GM in five. Based on BAL results, antifungal therapy was modified in seven patients. Conclusion: BAL fungal culture, BAL GM, and Aspergillus PCR testing are valuable diagnostic tools for pulmonary fungal infections in children, especially those with malignancy or immunodeficiency (ID). The observed treatment modifications following BAL results emphasize their clinical importance not only in establishing diagnosis but also in guiding and optimizing antifungal therapy.
