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Published on: March 22, 2012
Diagnosing invasive aspergillosis during antifungal therapy by PCR analysis of blood samples
Cornelia Lass-Flörl1, Eberhard Gunsilius, Günther Gastl
1Department of Hygiene and Social Medicine, University of Innsbruck, Innsbruck, Austria. Cornelia.Lass-Floerl@uibk.ac.at
Abstract:
We evaluated the value of Aspergillus PCR as a tool for diagnosing invasive aspergillosis from whole-blood samples during antifungal therapy. In a 3-year study, 36 patients receiving antifungal therapy due to chest radiographic findings highly suggestive of fungal pneumonia were evaluated. The PCR results from whole-blood samples were compared to those obtained from bronchoalveolar lavage fluids and/or tissue specimens. A total of 205 whole-blood samples, 15 fine-needle aspirations or tissue biopsy specimens, and 21 bronchoalveolar lavage fluids and tracheal secretions were analyzed using PCR. Of the 36 patients, 15 had proven, 9 had probable, and 12 had possible invasive Aspergillus infection according to European Organization for Research and Treatment of Cancer/Mycosis Study Group definitions. For patients with proven infection the sensitivity values of PCR in lung and blood samples were 100 and 40%, respectively. The negative predictive value of blood monitoring under conditions of antifungal treatment was 44%. Clearance of fungal DNA from blood was associated with resolution of clinical symptoms in six of nine patients with proven infection. Repeated positive PCR results for Aspergillus were associated with fatal outcome, as three of six patients died. For patients with probable infection the sensitivity values of PCR in lung fluid and blood were 66 and 44%, respectively. The benefit of PCR diagnosis using whole-blood samples is limited when sampling takes place after treatment has been started. Performance of Aspergillus PCR using tissue samples is recommended in addition to microscopic examination and culture technique for sensitive detection of fungal infection.
Insights
Aspergillus PCR in blood shows limited value for diagnosing invasive aspergillosis during antifungal therapy. Tissue PCR is recommended for sensitive fungal infection detection alongside traditional methods.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Diagnostic Microbiology
Background:
- Invasive aspergillosis is a serious fungal infection, often diagnosed late.
- Early diagnosis is crucial for effective antifungal therapy.
- Polymerase Chain Reaction (PCR) offers a potential method for rapid pathogen detection.
Purpose of the Study:
- To evaluate the diagnostic utility of Aspergillus PCR in whole-blood samples during antifungal therapy.
- To compare blood PCR results with bronchoalveolar lavage (BAL) and tissue specimen PCR.
- To assess the correlation between blood PCR findings and clinical outcomes.
Main Methods:
- A 3-year study involving 36 patients with suspected fungal pneumonia receiving antifungal therapy.
- Analysis of 205 whole-blood samples, 15 tissue/FNA specimens, and 21 BAL fluids using Aspergillus PCR.
- Classification of patients into proven, probable, and possible invasive aspergillosis categories.
Main Results:
- Sensitivity of blood PCR was 40% for proven and 44% for probable invasive aspergillosis.
- Lung fluid PCR sensitivity was 100% for proven and 66% for probable cases.
- Negative predictive value of blood PCR during treatment was 44%; clearance correlated with symptom resolution in some patients.
Conclusions:
- Aspergillus PCR in whole-blood samples has limited diagnostic value when initiated after antifungal therapy has begun.
- PCR on tissue samples is recommended for sensitive detection of invasive aspergillosis.
- Combined use of PCR on tissue samples with microscopy and culture enhances fungal infection diagnosis.
