Diagnosis of invasive aspergillosis by a commercial real-time PCR assay for Aspergillus DNA in bronchoalveolar lavage fluid samples from high-risk patients compared to a galactomannan enzyme immunoassay

Maurizio Sanguinetti, Livio Pagano, Leonello Fuso, Gennaro De Pascale, Massimo Antonelli, Giovanni Fadda, Brunella Posteraro, Riccardo Torelli, Morena Caira, Elena De Carolis, Giuseppe Bello, Adrian Moody

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101 Citations (Scopus)

Abstract

Culture-independent molecular techniques such as real-time PCRs offer the potential for early diagnosis of invasive aspergillosis (IA), thereby reducing the disease-associated mortality rate. PCR-based testing is presently excluded from disease-defining consensus criteria due to lack of standardization and clinical validation. A single-center prospective study was conducted to investigate the performance of the commercially available MycAssay Aspergillus test for detecting Aspergillus DNA in patients with suspicion of IA. To this end, a total of 158 bronchoalveolar lavage (BAL) fluid specimens that were consecutively collected from hematology (n = 68) and intensive care unit (n = 90) patients were examined. Sixteen of 17 (94.1%) specimens from patients with proven/probable IA were MycAssay positive, and 15 of these 16 patients were also positive by an "in-house" PCR assay. A total of 139 of 141 (98.6%) specimens from patients without proven/probable IA were MycAssay negative. Fifteen of 16 (94.1%) MycAssay-positive patients were also positive for BAL fluid galactomannan (GM) at an index cutoff of ≥1.0 (index range, 1.1 to 8.3), as were 3 patients without IA but with pulmonary fusariosis. Interestingly, in seven of the PCR-positive BAL specimens that tested culture positive for Aspergillus species, cycle threshold values were earlier than those of specimens with a culture-negative result. In conclusion, the MycAssay Aspergillus PCR appears to be a sensitive and specific molecular test for the diagnosis of IA, and its performance is comparable to that of the GM assay. However, more large studies are necessary to firmly establish its clinical utility in high-risk settings.
Original languageEnglish
Pages (from-to)4273-4278
Number of pages6
JournalJournal of Clinical Microbiology
Volume49
DOIs
Publication statusPublished - 2011

Keywords

  • Aspergillus
  • Bacteriological Techniques
  • Bronchoalveolar Lavage Fluid
  • Humans
  • Immunoenzyme Techniques
  • Mannans
  • Molecular Diagnostic Techniques
  • Prospective Studies
  • Pulmonary Aspergillosis
  • Real-Time Polymerase Chain Reaction
  • Sensitivity and Specificity

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