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A Seminested PCR Method for the Diagnosis of Invasive Fungal Infections in Combat Injured.

Graham C Ellis1, Faraz Shaikh2,3, M Leigh Carson2,3

  • 1Walter Reed National Military Medical Center, Bethesda, Maryland, USA.

Open Forum Infectious Diseases
|June 18, 2024
PubMed
Summary

New seminested assays show promise for diagnosing invasive fungal infections (IFIs) in combat-injured patients. These molecular methods offer a valuable alternative to traditional diagnostics, particularly for soft-tissue IFIs with angioinvasion.

Keywords:
PCR-based assayscombatinvasive fungal wound infectionmucormycosistrauma

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Area of Science:

  • Medical Mycology
  • Molecular Diagnostics
  • Infectious Diseases

Background:

  • Invasive fungal infections (IFIs) cause significant morbidity in combat-injured individuals.
  • Traditional diagnostic methods like cultures and histopathology for IFIs have limitations.
  • Previous research established the efficacy of a panfungal polymerase chain reaction (PCR) assay for angioinvasive IFIs.

Purpose of the Study:

  • To evaluate three less resource-intensive seminested PCR assays.
  • To target clinically relevant fungi: order Mucorales, and genera *Aspergillus* and *Fusarium*.
  • To assess the utility of these assays in formalin-fixed paraffin-embedded tissue samples from combat-injured patients.

Main Methods:

  • Utilized formalin-fixed paraffin-embedded tissue specimens from a multicenter trauma IFI cohort (2009-2014).
  • Compared seminested assays (targeting Mucorales, *Aspergillus*, *Fusarium*) with a panfungal assay and histopathology.
  • Included cases of US military personnel with histopathologic IFI evidence and controls with no laboratory IFI evidence.

Main Results:

  • Observed substantial agreement between seminested and panfungal assays, particularly for Mucorales.
  • Found moderate agreement at the genus level for *Aspergillus* and *Fusarium*.
  • Seminested assays demonstrated 67.4% sensitivity and 96.6% specificity compared to histopathology, with sensitivity reaching 91.7% for angioinvasive sites.

Conclusions:

  • The seminested approach is useful for diagnosing soft-tissue IFIs in formalin-fixed paraffin-embedded tissue.
  • Findings support the utility of seminested molecular diagnostics in a combat-injured population.
  • This approach is particularly effective for IFIs with angioinvasion.