Abstract
Invasive aspergillosis is a severe complication of cytotoxic chemotherapies and bone marrow transplantation (BMT). The aim of this study was to assess the utility of a real-time PCR assay for the early diagnosis of Aspergillus species in blood samples from BMT patients. Blood specimens (n = 993) from patients (n = 82) scheduled for BMT were collected prior to transplant and for 100 days post transplantation. The specimens were later tested using an Aspergillus-specific real-time PCR assay. Cultures of clinical samples, along with sonography and computerized tomographic scans, were performed as standard of care. Aspergillus DNA was positive in 94 sequential blood samples from 13 patients with clinical and radiological signs of infection. Samples from three of these patients were PCR-positive for Aspergillus in the first week of admission, prior to transplantation. Four patients with aspergillosis were cured with antifungal agents and nine died. An additional 12 patients without clinical signs of infection were PCR-positive on one occasion each, while two patients with clinical signs of infection were PCR-negative. Compared to routine methods of aspergillosis diagnosis, the respective sensitivity, specificity, negative, and positive predictive values of the PCR method by patient were 86.6%, 82%, 96.5% and 52%. The results show that Aspergillus infections in the blood of bone marrow transplant patients can be dectected by PCR methods. Early detection of Aspergillus infections by PCR has the potential to positively impact patient mortality rate and provide cost savings to hospitals.
Highlights
Invasive aspergillosis is a severe complication of cytotoxic chemotherapies and bone marrow transplantation (BMT)
The aim of this study was to assess the utility of a real-time PCR assay for the early diagnosis of Aspergillus species in blood samples of bone marrow transplantation (BMT) recipients for early diagnosis
We evaluated the recipients for 100 days after transplantation to cover these intervals, and the mean time of invasive aspergillosis clinical manifestations was 43 days
Summary
Invasive aspergillosis is a severe complication of cytotoxic chemotherapies and bone marrow transplantation (BMT). The aim of this study was to assess the utility of a real-time PCR assay for the early diagnosis of Aspergillus species in blood samples from BMT patients. Results: Aspergillus DNA was positive in 94 sequential blood samples from 13 patients with clinical and radiological signs of infection. Samples from three of these patients were PCR-positive for Aspergillus in the first week of admission, prior to transplantation. Conclusions: The results show that Aspergillus infections in the blood of bone marrow transplant patients can be dectected by PCR methods. Detection of Aspergillus infections by PCR has the potential to positively impact patient mortality rate and provide cost savings to hospitals. The mortality rate can exceed 90% in bone marrow transplant recipients (BMTR) [3] Survival of such patients depends on early diagnosis and prompt therapy. The galactomannan test has reached a satisfactory level of confidence, in some studies, to be included as the diagnostic tool of invasive aspergillosis in hematology, despite a high level of false positive results (~10-15%) [6,7,8]
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