Evaluation of MucorGenius® mucorales PCR assay for the diagnosis of pulmonary mucormycosis

Guegan, Hélène; Iriart, Xavier; Bougnoux, Marie‐Elisabeth; Berry, Antoine; Robert‐Gangneux, Florence; Gangneux, Jean‐Pierre

doi:10.1016/j.jinf.2020.05.051

Cited by 66 publications

(51 citation statements)

References 40 publications

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“…Recent studies have confirmed the value of qPCR in BAL, with regard to earlier diagnosis and better outcomes in cases of pulmonary mucormycosis [102][103][104][105][106][107][108][109][110][111][112][113].…”

Section: Applied and Emerging Molecular Methodsmentioning

confidence: 87%

“…and Cunninghamella spp. [111]. The commercial assay was user friendly and all qPCR assays used in the study were superior to conventional methods to detect fungal DNA.…”

Section: Applied and Emerging Molecular Methodsmentioning

confidence: 99%

“…The commercial assay was user friendly and all qPCR assays used in the study were superior to conventional methods to detect fungal DNA. Drawbacks of the method are that genus identification is not possible, and that it may not detect low fungal burden infections [111].…”

Section: Applied and Emerging Molecular Methodsmentioning

confidence: 99%

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Epidemiology and Diagnosis of Mucormycosis: An Update

Skiada

Pavleas

Drogari‐Apiranthitou

2020

JoF

517

508

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Mucormycosis is an angioinvasive fungal infection, due to fungi of the order Mucorales. Its incidence cannot be measured exactly, since there are few population-based studies, but multiple studies have shown that it is increasing. The prevalence of mucormycosis in India is about 80 times the prevalence in developed countries, being approximately 0.14 cases per 1000 population. Diabetes mellitus is the main underlying disease globally, especially in low and middle-income countries. In developed countries the most common underlying diseases are hematological malignancies and transplantation. Τhe epidemiology of mucormycosis is evolving as new immunomodulating agents are used in the treatment of cancer and autoimmune diseases, and as the modern diagnostic tools lead to the identification of previously uncommon genera/species such as Apophysomyces or Saksenaea complex. In addition, new risk factors are reported from Asia, including post-pulmonary tuberculosis and chronic kidney disease. New emerging species include Rhizopus homothallicus, Thamnostylum lucknowense, Mucor irregularis and Saksenaea erythrospora. Diagnosis of mucormycosis remains challenging. Clinical approach to diagnosis has a low sensitivity and specificity, it helps however in raising suspicion and prompting the initiation of laboratory testing. Histopathology, direct examination and culture remain essential tools, although the molecular methods are improving. The internal transcribed spacer (ITS) region is the most widely sequenced DNA region for fungi and it is recommended as a first-line method for species identification of Mucorales. New molecular platforms are being investigated and new fungal genetic targets are being explored. Molecular-based methods have gained acceptance for confirmation of the infection when applied on tissues. Methods on the detection of Mucorales DNA in blood have shown promising results for earlier and rapid diagnosis and could be used as screening tests in high-risk patients, but have to be validated in clinical studies. More, much needed, rapid methods that do not require invasive procedures, such as serology-based point-of-care, or metabolomics-based breath tests, are being developed and hopefully will be evaluated in the near future.

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Section: Applied and Emerging Molecular Methodsmentioning

confidence: 87%

“…and Cunninghamella spp. [111]. The commercial assay was user friendly and all qPCR assays used in the study were superior to conventional methods to detect fungal DNA.…”

Section: Applied and Emerging Molecular Methodsmentioning

confidence: 99%

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Epidemiology and Diagnosis of Mucormycosis: An Update

Skiada

Pavleas

Drogari‐Apiranthitou

2020

JoF

517

508

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“…Similar to our study, a low yield of BAL fluid cytology and culture in identifying Aspergillus and Mucorales has been reported previously 11,12 . The advent of pan‐fungal and species‐specific nucleic acid amplification methods from the BAL fluid is likely to improve the diagnostic yield in identifying moluds 13–16 …”

Section: Discussionmentioning

confidence: 99%

Role of flexible bronchoscopy in the diagnosis of invasive fungal infections

Muthu

Gandra

Dhooria

et al. 2021

Mycoses

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Background There are sparse data on the role of flexible bronchoscopy (FB) in diagnosing invasive mould infections (IMIs). Objective To investigate the safety and usefulness of FB in IMI. We evaluate the factors associated with a successful diagnosis of IMI using FB. Further, we compare subjects of invasive pulmonary aspergillosis (IPA) with pulmonary mucormycosis (PM). Methods We retrospectively reviewed the clinical features, imaging data, bronchoscopy, microbiology and pathology details of subjects who underwent FB for suspected IMI. We categorised FB as diagnostic if it contributed to the diagnosis of IMI. We performed a multivariate analysis to identify the factors associated with a diagnostic bronchoscopy. Results Of the 3521 FB performed over 18 months, 132 (3.7%) were done for suspected IMIs. We included 107 subjects for the final analysis. The risk factors for IMI included renal transplantation (29.0%), diabetes (27.1%), haematological malignancy (10.3%) and others. We found bronchoscopic abnormalities in 33 (30.8%) subjects, and these were more frequent in those with confirmed PM (67%) than IPA (27%). IMI was confirmed in 79 (14 proven, 48 probable and 17 possible) subjects. FB was diagnostic in 71%. We experienced major complications in three cases (2.7%), including one death. On multivariate analysis, the visualisation of endobronchial abnormalities during FB (OR [95%, CI], 8.5 [1.4–50.4]) was the only factor associated with a diagnostic FB after adjusting for age and various risk factors. Conclusions Flexible bronchoscopy is a useful and safe procedure in diagnosing IMIs. The presence of endobronchial abnormalities predicts a successful diagnostic yield on FB.

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“…PCR combined with high-resolution melt analysis (PCR/HRMA) has also been described, and showed a sensitivity and specificity of 100% and 93% in one study of 99 BAL samples (9 of which were positive) [122]. MucorGenius (Pathonostics, Maastricht, The Netherlands), is a non-FDA approved semi-quantitative PCR assay that targets 28S rRNA in BAL and biopsy samples and can be run in parallel with AsperGenius, with a TAT of 3 h [140,123].…”

Section: Mucorales-specific Pcrmentioning

confidence: 99%