Polymerase chain reaction screening for fungemia and/or invasive fungal infections in patients with hematologic malignancies

Ribeiro, Patrícia Lisbôa Izetti; Costa, Fátima; Monteiro, Alexandra; Caldas, Joana; Silva, Madalena Pereira da; Ferreira, Gilda Aparecida; Veiga, Joana; Sousa, Manuel Alves de; Viegas, Maria P.; Santos, Ester; Gonçalves, Antônio José; Sousa, Aïda Botelho de

doi:10.1007/s00520-005-0903-7

Cited by 13 publications

(10 citation statements)

References 27 publications

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“…15,17,34 No conclusions regarding multiple [15][16][17]34,35 In our study, we did not find that PCR tests for Aspergillus were useful in patients with proven or probable IA. Fungal PCR tests were performed within 2 weeks of diagnosis in six of nine patients with proven or probable IA, and only one patient had a positive PCR test.…”

Section: Discussioncontrasting

confidence: 70%

Randomized PCR-based therapy and risk factors for invasive fungal infection following reduced-intensity conditioning and hematopoietic SCT

Blennow

Remberger

Klingspor

et al. 2010

Bone Marrow Transplant

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Invasive fungal infections (IFIs) are major complications after allogeneic hematopoietic SCT (HSCT). PCR-based assays able to detect fungal DNA have been reported to precede clinical diagnosis of IFI. We performed a prospective study to evaluate a PCR-based pre-emptive approach. Ninety-nine patients undergoing reduced-intensity conditioning (RIC) HSCT were followed with fungal PCR during the first 100 days post transplantation. Patients who tested positive were randomized to receive liposomal amphotericin B, or to no intervention. After day 100, PCR tests were performed only on clinical suspicion of IFI. A single positive PCR test was not associated with IFI, irrespective of treatment. After day 100, PCR tests for Aspergillus did not contribute to diagnosis of invasive aspergillosis (IA). The cumulative incidence rates of proven or probable IA during the first year after transplantation were 9%. GVHD grades II-IV (P ¼ 0.0014), CMV-seronegative recipient with CMVseropositive donor (Pp0.001), and conditioning with alemtuzumab (P ¼ 0.014) were significant risk factors for developing IA in a multivariate model. In this study, PCR on peripheral blood was a poor indicator of IFI early after RIC HSCT. Aspergillus PCR tests performed on clinical suspicion after day 100 were insufficiently sensitive to be diagnostically useful.

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Section: Discussioncontrasting

confidence: 70%

Randomized PCR-based therapy and risk factors for invasive fungal infection following reduced-intensity conditioning and hematopoietic SCT

Blennow

Remberger

Klingspor

et al. 2010

Bone Marrow Transplant

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“…In such cases, PCR facilitates species identification, which cannot be achieved through microscopy but can serve an important role in guiding antifungal therapy. Multiplex PCR has also been tested as a method to detect fungal species in whole-blood (236,238,(243)(244)(245), serum (246), or BAL fluid (247) samples from patients at high risk for IFIs. The results are variable, but most studies report superior sensitivities and specificities of Ͼ80% (236,238,243,248).…”

Section: Pcrmentioning

confidence: 99%

Molecular and Nonmolecular Diagnostic Methods for Invasive Fungal Infections

et al. 2014

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SUMMARY Invasive fungal infections constitute a serious threat to an ever-growing population of immunocompromised individuals and other individuals at risk. Traditional diagnostic methods, such as histopathology and culture, which are still considered the gold standards, have low sensitivity, which underscores the need for the development of new means of detecting fungal infectious agents. Indeed, novel serologic and molecular techniques have been developed and are currently under clinical evaluation. Tests like the galactomannan antigen test for aspergillosis and the β-glucan test for invasive Candida spp. and molds, as well as other antigen and antibody tests, for Cryptococcus spp., Pneumocystis spp., and dimorphic fungi, have already been established as important diagnostic approaches and are implemented in routine clinical practice. On the other hand, PCR and other molecular approaches, such as matrix-assisted laser desorption ionization (MALDI) and fluorescence in situ hybridization (FISH), have proved promising in clinical trials but still need to undergo standardization before their clinical use can become widespread. The purpose of this review is to highlight the different diagnostic approaches that are currently utilized or under development for invasive fungal infections and to identify their performance characteristics and the challenges associated with their use.

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“…After DNA amplification, amplicons can be detected and quantified. In older techniques, amplicons underwent postamplification handling, such as restriction fragment-length polymorphism analysis or Southern blotting, resulting in significant delays and prolonged environmental exposure of the samples [37][38][39]. Newer real-time PCR platforms use fluorescent probes concurrently with the PCR [40].…”

Section: Description and Challenges Of Pcr Fungal Diagnostic Assaysmentioning

confidence: 99%

Polymerase Chain Reaction-Based Assays for the Diagnosis of Invasive Fungal Infections

Kourkoumpetis

Fuchs

Coleman

et al. 2012

Clinical Infectious Diseases

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Currently accepted fungal diagnostic techniques, such as culture, biopsy, and serology, lack rapidity and efficiency. Newer diagnostic methods, such as polymerase chain reaction (PCR)-based assays, have the potential to improve fungal diagnostics in a faster, more sensitive, and specific manner. Preliminary data indicate that, when PCR-based fungal diagnostic assays guide antifungal therapy, they may lower patient mortality and decrease unnecessary antifungal treatment, improving treatment-associated costs and avoiding toxicity. Moreover, newer PCR techniques can identify antifungal resistance DNA loci, but the clinical correlation between those loci and clinical failure has to be studied further. In addition, future studies need to focus on the implementation of PCR techniques in clinical decision making and on combining them with other diagnostic tests. A consensus on the standardization of PCR techniques, along with validation from large prospective studies, is necessary to allow widespread adoption of these assays.

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Polymerase chain reaction screening for fungemia and/or invasive fungal infections in patients with hematologic malignancies

Cited by 13 publications

References 27 publications

Randomized PCR-based therapy and risk factors for invasive fungal infection following reduced-intensity conditioning and hematopoietic SCT

Randomized PCR-based therapy and risk factors for invasive fungal infection following reduced-intensity conditioning and hematopoietic SCT

Molecular and Nonmolecular Diagnostic Methods for Invasive Fungal Infections

Polymerase Chain Reaction-Based Assays for the Diagnosis of Invasive Fungal Infections

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