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PCR diagnostic platforms for non-Aspergillus mold infections: ready for routine implementation in the clinic?
Frederic Lamoth1,2, Dimitrios P Kontoyiannis3
1Infectious Diseases Service, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
Introduction:
While Aspergillus spp. remain the predominant cause of invasive mold infections, non-Aspergillus molds, such as the Mucorales or Fusarium spp., account for an increasing proportion of cases. The diagnosis of non-Aspergillus invasive mold infections (NAIMI) is challenging because of the low sensitivity and delay of conventional microbiological tests. Therefore, there is a particular interest to develop molecular tools for their early detection in blood or other clinical samples.
Areas Covered:
This extensive review of the literature discusses the performance of Mucorales-specific PCR and other genus-specific or broad-range fungal PCR that can be used for the diagnosis of NAIMI in diverse clinical samples, with a focus on novel technologies.
Expert Opinion:
PCR currently represents the most promising approach, combining good sensitivity/specificity and ability to detect NAIMI in clinical samples before diagnosis by conventional cultures and histopathology. Several PCR assays have been designed for the detection of Mucorales in particular, but also Fusarium spp. or Scedosporium/Lomentospora spp. Some commercial Mucorales PCRs are now available. While efforts are still needed for standardized protocols and the development of more rapid and simpler techniques, PCR is on the way to becoming an essential test for the early diagnosis of mucormycosis and possibly other NAIMIs.
Insights
Early detection of non-Aspergillus invasive mold infections (NAIMI) is crucial. Polymerase chain reaction (PCR) shows promise for diagnosing NAIMI in clinical samples, offering better sensitivity and speed than traditional methods.
Area of Science:
- Medical Mycology
- Molecular Diagnostics
- Infectious Diseases
Background:
- Invasive mold infections are increasingly caused by non-Aspergillus species, including Mucorales and Fusarium.
- Conventional diagnostic methods for these infections have limitations in sensitivity and speed.
- Early and accurate diagnosis of non-Aspergillus invasive mold infections (NAIMI) is critical for patient outcomes.
Purpose of the Study:
- To review the performance of molecular diagnostic tools, particularly Polymerase Chain Reaction (PCR), for detecting NAIMI.
- To highlight novel technologies and their application in diagnosing infections caused by non-Aspergillus molds.
- To assess the potential of PCR as a primary diagnostic method for NAIMI.
Main Methods:
- Literature review focusing on PCR-based diagnostic assays for NAIMI.
- Analysis of PCR performance in detecting various non-Aspergillus fungi (Mucorales, Fusarium, Scedosporium/Lomentospora).
- Evaluation of PCR in different clinical sample types.
Main Results:
- PCR assays demonstrate good sensitivity and specificity for detecting NAIMI.
- Molecular methods can identify NAIMI earlier than conventional cultures and histopathology.
- Commercial PCR tests for Mucorales are becoming available, with ongoing development for other NAIMI pathogens.
Conclusions:
- PCR is a highly promising approach for the early diagnosis of NAIMI.
- Standardization of protocols and development of faster, simpler techniques are needed.
- PCR is poised to become an essential tool for diagnosing mucormycosis and other NAIMIs.
