Abstract
PurposeDue to an increasing incidence of invasive fungal infections, the availability of reliable diagnostic tools for the fast detection of a wide spectrum of fungal pathogens is of vital importance. In this study, we aimed to conduct an extensive clinical evaluation of a recently published in-house panfungal PCR assay on samples from suspected invasive fungal infections.MethodsOverall 265 clinical samples from 232 patients with suspected invasive fungal disease (96 deep airway samples, 60 sterile fluids, 50 tissue biopsies, and 59 blood samples) were included. All samples underwent standard culture-based diagnostics and were additionally analyzed with our panfungal PCR assay.ResultsOverall, 55.1% of agreement between culture and the panfungal PCR was observed; in 17% of all samples partial concordance was noted, while results between culture and our PCR assay were not in agreement in 27.9%. Our panfungal assay performed better in samples from normally sterile sites, while samples from the deep airways yielded the highest rate of discordant (39.6%) results. In two tissue and three blood samples an invasive pathogen was only detected by PCR while cultures remained negative.ConclusionIn combination with routine methods, our panfungal PCR assay is a valuable diagnostic tool. Patients at risk for invasive fungal infections might profit from the reduced time to pathogen identification.
Highlights
Advances of modern medicine have led to the increased availability and use of immunosuppressant drugs, and an ever growing number of immunosuppressed patients
Sterile fluids and samples from the deep airways were divided in two parts; one part was analyzed by routine methods such as microscopy and culture, and the second part was used for DNA isolation and our panfungal PCR assay
Our results show that the diagnostic value of panfungal PCR assays might be hampered by the presence of fungal airway colonizers when samples from the deep airways are examined
Summary
Advances of modern medicine have led to the increased availability and use of immunosuppressant drugs, and an ever growing number of immunosuppressed patients These patients are at high risk for invasive fungal infections, and infections with rare fungal pathogens are gaining relevance [1,2,3,4,5,6,7,8,9,10,11]. The SepsiTestTM is marketed by Molzym (Molzym Molecular Diagnostic, Bremen, Germany), and targets the 16S rRNA gene for bacteria, and the 18S rRNA gene for fungi In addition to this assay, few research use only (RUO) tests like the Fungiplex Universal RUO PCR kit (Bruker Daltonik, Bremen, Germany) are commercially available, and a number of in-house panfungal assays have been described [21, 23,24,25,26,27,28,29,30]. In the present study we wanted to conduct a larger scale clinical evaluation of our assay as a screening tool for fungal infections
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