• Medientyp: E-Artikel
  • Titel: Aspergillus specific nested PCR from the site of infection is superior to testing concurrent blood samples in immunocompromised patients with suspected invasive aspergillosis
  • Beteiligte: Boch, Tobias; Spiess, Birgit; Heinz, Werner; Cornely, Oliver A.; Schwerdtfeger, Rainer; Hahn, Joachim; Krause, Stefan W.; Duerken, Matthias; Bertz, Hartmut; Reuter, Stefan; Kiehl, Michael; Claus, Bernd; Deckert, Peter Markus; Hofmann, Wolf‐Karsten; Buchheidt, Dieter; Reinwald, Mark
  • Erschienen: Wiley, 2019
  • Erschienen in: Mycoses
  • Sprache: Englisch
  • DOI: 10.1111/myc.12983
  • ISSN: 0933-7407; 1439-0507
  • Schlagwörter: Infectious Diseases ; Dermatology ; General Medicine
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  • Beschreibung: <jats:title>Summary</jats:title><jats:p>Invasive aspergillosis (<jats:styled-content style="fixed-case">IA</jats:styled-content>) is a severe complication in immunocompromised patients. Early diagnosis is crucial to decrease its high mortality, yet the diagnostic gold standard (histopathology and culture) is time‐consuming and cannot offer early confirmation of <jats:styled-content style="fixed-case">IA</jats:styled-content>. Detection of <jats:styled-content style="fixed-case">IA</jats:styled-content> by polymerase chain reaction (<jats:styled-content style="fixed-case">PCR</jats:styled-content>) shows promising potential. Various studies have analysed its diagnostic performance in different clinical settings, especially addressing optimal specimen selection. However, direct comparison of different types of specimens in individual patients though essential, is rarely reported. We systematically assessed the diagnostic performance of an <jats:italic>Aspergillus</jats:italic>‐specific nested <jats:styled-content style="fixed-case">PCR</jats:styled-content> by investigating specimens from the site of infection and comparing it with concurrent blood samples in individual patients (pts) with <jats:styled-content style="fixed-case">IA</jats:styled-content>. In a retrospective multicenter analysis <jats:styled-content style="fixed-case">PCR</jats:styled-content> was performed on clinical specimens (n = 138) of immunocompromised high‐risk pts (n = 133) from the site of infection together with concurrent blood samples. 38 pts were classified as proven/probable, 67 as possible and 28 as no <jats:styled-content style="fixed-case">IA</jats:styled-content> according to 2008 European Organization for Research and Treatment of Cancer/Mycoses Study Group consensus definitions. A considerably superior performance of <jats:styled-content style="fixed-case">PCR</jats:styled-content> from the site of infection was observed particularly in pts during antifungal prophylaxis (<jats:styled-content style="fixed-case">AFP</jats:styled-content>)/antifungal therapy (<jats:styled-content style="fixed-case">AFT</jats:styled-content>). Besides a specificity of 85%, sensitivity varied markedly in <jats:styled-content style="fixed-case">BAL</jats:styled-content> (64%), <jats:styled-content style="fixed-case">CSF</jats:styled-content> (100%), tissue samples (67%) as opposed to concurrent blood samples (8%). Our results further emphasise the need for investigating clinical samples from the site of infection in case of suspected <jats:styled-content style="fixed-case">IA</jats:styled-content> to further establish or rule out the diagnosis.</jats:p>