Prospective Evaluation of a Polymerase Chain Reaction–ELISA Targeted to<i>Aspergillus fumigatus</i>and<i>Aspergillus flavus</i>for the Early Diagnosis of Invasive Aspergillosis in Patients with Hematological Malignancies

Florent, Martine; Katsahian, Sandrine; Vekhoff, Anne; Lévy, Vincent; Rio, Bernard; Marie, Jean‐Pierre; Bouvet, Anne; Cornet, Muriel

doi:10.1086/500466

Cited by 103 publications

(81 citation statements)

References 35 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: 67%

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: 67%

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

View full text Add to dashboard Cite

show abstract

“…12 A French investigation confirmed the improvement of early diagnosis of proven or probable invasive aspergillosis by PCR assays of serum samples showing a sensitivity of 63.6% and a specificity of 89.7%. 13 Frequent PCR testing in patients with a high risk of IFI (for example, patients after SCT) may enable a diagnosis of IFI before the onset of symptoms and an earlier start of treatment. 12 However, PCR is not considered as a microbiological tool for the diagnosis of IFI in the new European Organization for Research and Treatment of Cancer/Infectious Diseases Mycoses Study Group (EORTC/MSG) definitions.…”

Section: Introductionmentioning

confidence: 99%

A prospective randomized controlled trial comparing PCR-based and empirical treatment with liposomal amphotericin B in patients after allo-SCT

Hebart

Klingspor

Klingebiel

et al. 2008

Bone Marrow Transplant

109

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“…However, false-positive GM results frequently occur (21,27). A combination of GM detection with other types of biomarker detection, including circulating DNA, could be a good way to improve early diagnosis of IA (12,15,29).…”

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confidence: 99%

Ribosomal and Mitochondrial DNA Target for Real-Time PCR Diagnosis of Invasive Aspergillosis

et al. 2011

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The aim of the present study was to assess the diagnostic efficacy of a combination of two quantitative Aspergillus PCR assays, targeting a mitochondrial and a ribosomal target, in patients with risk factors for invasive aspergillosis (IA) and positive galactomannan (GM) antigen. Forty-four patients with hematological malignancies and risk factors for IA according to revised European Organization for Research on Treatment of Cancer and the Mycoses Study Group criteria (EORTC/MSG) criteria and presenting at least two sequential GM-positive sera were included in the study. Mitochondrial PCR was carried out prospectively on all GMpositive serum samples. Ribosomal PCR was carried out retrospectively on frozen stored sera. The sensitivities of mitochondrial and ribosomal PCRs were 58% and 50%, respectively. The diagnostic test performance was improved by using a combination of both PCR assays and by considering a patient PCR positive when at least two positive results were obtained. The sensitivity, specificity, and positive and negative likelihood ratios were 65%, 94%, and 11.8 and 0.37, respectively. A significant association between fatal outcome at 90 days and positive results of ribosomal PCR assays was observed (adjusted hazard ratio ‫؍‬ 8.2; 95% confidence interval [CI] ‫؍‬ 1.0 to 65.8; P ‫؍‬ 0.048). Our results showed that the combination of two PCR assays targeting mitochondrial and ribosomal Aspergillus DNA improves the sensitivity of PCR in the diagnosis of IA in hematological patients with risk factors and positive GM results. This study also confirms that a positive PCR result is associated with a poor prognosis in these patients and should lead to specific antifungal therapy being introduced immediately.

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Prospective Evaluation of a Polymerase Chain Reaction–ELISA Targeted toAspergillus fumigatusandAspergillus flavusfor the Early Diagnosis of Invasive Aspergillosis in Patients with Hematological Malignancies

Abstract: In addition to serial screening for GM antigenemia and radiological surveillance, PCR-ELISA may improve the rates of early diagnosis of IA and the management of patients with hematological malignancies.

Cited by 103 publications

References 35 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

A prospective randomized controlled trial comparing PCR-based and empirical treatment with liposomal amphotericin B in patients after allo-SCT

Ribosomal and Mitochondrial DNA Target for Real-Time PCR Diagnosis of Invasive Aspergillosis

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