Diagnostic accuracy of fungal PCR and β-d-glucan for detection of candidaemia: a preliminary evaluation

McKeating, Cara; White, P. Lewis; Posso, Raquel; Palmer, Michael; Johnson, Elizabeth; McMullan, Ronan

doi:10.1136/jclinpath-2017-204692

Cited by 15 publications

(14 citation statements)

References 16 publications

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“…Due to a small array of symptoms and supportive laboratory data, a diagno-sis of prompt arthrocentesis can be made. Previous articles described β-D glucan in the blood as an effective measure for helping diagnosis fungal infections [7]. Although this patient presented standard β-D glucan levels at the time of revision surgery, the value gradually decreased as intake of Fluconazole increased.…”

Section: Discussionmentioning

confidence: 71%

Candidal Prosthetic Hip Infection in a Patient with Previous Candidal Sepsis – A Case Report –

Murata

Okabe

Tamagawa³

et al. 2020

J UOEH

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A 60 year-old woman with hip dysplasia battled with duodenal cancer that was complicated with Candida tropicalis sepsis. Two years later, the patient underwent a total hip arthroplasty (THA). She complained of a persisting low-grade fever and local heat on the THA scar. Arthrocentesis of the hip was performed and the Candida tropicalis was detected. Debridement and polyethylene liner/modular head exchange were performed 28 days after the primary THA. Fluconazole was administrated for one year. The patient reported no symptoms five years later. It was found that periprosthetic infection could be prevented by implant preservation surgery.

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Section: Discussionmentioning

confidence: 71%

Candidal Prosthetic Hip Infection in a Patient with Previous Candidal Sepsis – A Case Report –

Murata

Okabe

Tamagawa³

et al. 2020

J UOEH

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“…The only other study to investigate a standardized, certified, and commercially available multiplex PCR, the RenDx Fungiplex kit, reported results similar to our findings (sensitivity of 44% and specificity of 87%). However, that study was also based on a very small number of only nine cases of candidemia [36]. The high variability in target sequences might be the reason for the low sensitivity of different Candida-specific PCR assays.…”

Section: Discussionmentioning

confidence: 97%

“…For years, there have been calls for non-culture-based methods to overcome these limitations, with high expectations for molecular techniques [7,11,15]. Since the first attempts at molecular candidemia diagnostics in the early 1990s [19][20][21], several in-house and a few commercial molecular tests have been developed, demonstrating sensitivities varying widely from 25% to 100% [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37]. Probable explanations for these discrepant results include different sample volumes, different DNA extraction protocols, and particularly statistical effects due to the overall low case numbers.…”

Section: Discussionmentioning

confidence: 99%

Performance of Multiplex PCR and β-1,3-D-Glucan Testing for the Diagnosis of Candidemia

Koc

Kessler

Hoenigl

et al. 2022

JoF

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Bloodstream infections caused by Candida yeasts (candidemia) are associated with high morbidity and mortality. Diagnosis remains challenging, with the current gold standard—isolation from blood culture (BC)—being limited by low sensitivity and long turnaround time. This study evaluated the performance of two nonculture methods: PCR and β-1,3-D-glucan (BDG) testing. The sera of 103 patients with BC-proven candidemia and of 46 controls were analyzed with the Fungiplex Candida Real-Time PCR and the Wako β-Glucan Test. The BDG assay demonstrated higher sensitivity than the multiplex PCR (58% vs. 33%). This was particularly evident in ICU patients (60% vs. 28%) and in C. albicans candidemia (57% vs. 37%). The earlier prior to BC sampling the sera were obtained, the more the PCR sensitivity decreased (46% to 18% in the periods of 0–2 and 3–5 days before BC, respectively), while BDG testing was independent of the sampling date. No positive PCR results were obtained in sera sampled more than five days before BC. Specificities were 89% for BDG and 93% for PCR testing. In conclusion, BDG testing demonstrated several advantages over PCR testing for the diagnosis of candidemia, including higher sensitivity and earlier diagnosis. However, BC remains essential, as BDG does not allow for species differentiation.

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“…This highlights the importance of treatment algorithms for fungal PJIs to avoid the loss of the infected limb. In this regard, prompt and reliable detection of an involvement of fungal microorganisms in PJI, which is often hampered by the low sensitivity of single detection methods [ 47 , 48 ], is essential for the success of the treatment.…”

Section: Discussionmentioning

confidence: 99%

Periprosthetic Fungal Infections in Severe Endoprosthetic Infections of the Hip and Knee Joint—A Retrospective Analysis of a Certified Arthroplasty Centre of Excellence

Enz¹,

Mueller

Warnke³

et al. 2021

JoF

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The treatment of periprosthetic joint infections (PJI), and especially of re-infections, poses a highly complex problem in orthopaedic surgery. While fungal infections are rare, they present a special challenge. The therapy is often protracted and based on limited evidence. A total of 510 hip and knee revision surgeries were analysed for the occurrence of bacterial and fungal PJI. In patients with PJI, the duration of the hospital stay and the incidence of disarticulation of the infected joint were recorded. Out of the analysed revision arthroplasties, 43.5% were due to PJI. Monomicrobial infection occurred in 55.2%, dual microbial infection in 21.4%, and polymicrobial (≥3 different bacterial or fungal species) infection in 17.2% of the cases. Overall, Candida species were detected in 12.4% cases. Candida albicans was the main fungal pathogen. In 6.9% of cases, disarticulation of the joint was the only option to control PJI. The detection of polymicrobial infection more than doubled in follow-up revisions and there was a strong association between detection of Candida infection and disarticulation (OR 9.39). The majority of fungal infections were mixed infections of bacteria and Candida albicans. The choice of a biofilm penetrating antimycotic, e.g., caspofungin, together with a sufficient standard procedure for detection and surgical treatment can help to control the infection situation. Fungal infection often proves to be more difficult to treat than anticipated and is more frequent than expected.

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Diagnostic accuracy of fungal PCR and β-d-glucan for detection of candidaemia: a preliminary evaluation

Abstract: A combination of tests, or a single test at multiple time points, may be preferable to relying on one test at a single time point. This should be accounted for in design of future diagnostic accuracy studies of tests for invasive candidosis.

Cited by 15 publications

References 16 publications

Candidal Prosthetic Hip Infection in a Patient with Previous Candidal Sepsis – A Case Report –

Candidal Prosthetic Hip Infection in a Patient with Previous Candidal Sepsis – A Case Report –

Performance of Multiplex PCR and β-1,3-D-Glucan Testing for the Diagnosis of Candidemia

Periprosthetic Fungal Infections in Severe Endoprosthetic Infections of the Hip and Knee Joint—A Retrospective Analysis of a Certified Arthroplasty Centre of Excellence

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