Aspergillus Polymerase Chain Reaction: Systematic Review of Evidence for Clinical Use in Comparison With Antigen Testing.

Abstract

BACKGROUND:

Aspergillus polymerase chain reaction (PCR) was excluded from the European Organisation for the Research and Treatment of Cancer/Mycoses Study Group (EORTC/MSG) definitions of invasive fungal disease because of limited standardization and validation. The definitions are being revised.

METHODS:

A systematic literature review was performed to identify analytical and clinical information available on inclusion of galactomannan enzyme immunoassay (GM-EIA) (2002) and β-d-glucan (2008), providing a minimal threshold when considering PCR. Categorical parameters and statistical performance were compared.

RESULTS:

When incorporated, GM-EIA and β-d-glucan sensitivities and specificities for diagnosing invasive aspergillosis were 81.6% and 91.6%, and 76.9% and 89.4%, respectively. Aspergillus PCR has similar sensitivity and specificity (76.8%-88.0% and 75.0%-94.5%, respectively) and comparable utility. Methodological recommendations and commercial PCR assays assist standardization. Although all tests have limitations, currently, PCR is the only test with independent quality control.

CONCLUSIONS:

We propose that there is sufficient evidence that is at least equivalent to that used to include GM-EIA and β-d-glucan testing, and that PCR is now mature enough for inclusion in the EORTC/MSG definitions.

• Authors: P Lewis White, John R Wingard, Stéphane Bretagne, Jürgen Löffler, Thomas F Patterson, Monica A Slavin, Rosemary A Barnes, Peter G Pappas, J Peter Donnelly
• Journal: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America (Clin Infect Dis) Vol. 61 Issue 8 Pg. 1293-303 (Oct 15 2015) ISSN: 1537-6591 [Electronic] United States
• PMID: 26113653 (Publication Type: Comparative Study, Journal Article, Review, Systematic Review)
• Copyright: © The Author 2015. Published by Oxford University Press on behalf of the Infectious Diseases Society of America.

Chemical References

• Antigens, Fungal
• Mannans
• beta-Glucans
• galactomannan
• Galactose

Topics

• Antigens, Fungal (analysis)
• Aspergillosis (diagnosis)
• Aspergillus (genetics, immunology, isolation & purification)
• Galactose (analogs & derivatives)
• Humans
• Immunoenzyme Techniques (statistics & numerical data)
• Mannans (analysis)
• Polymerase Chain Reaction (standards, statistics & numerical data)
• Quality Control
• Sensitivity and Specificity
• beta-Glucans (analysis)