Abstract
Objectives: to analyze the results of molecular methods applying for the diagnosis of mucormycosis in hematologic patients based on a literature review. Data sources: A systematic search in databases PubMed, Google Scholar for August 2019. Review eligibility criteria: original articles published in English, studies of molecular methods for the diagnosis of mucormycosis in hematologic patients. Results. We analyzed the research data from 116 hematological patients with mucormycosis, including children (6%). Patients with localized forms of mucormycosis prevailed (72%), and lung involvement was diagnosed in 58% of these cases. For molecular verification of the causative agent of mucormycosis, blood serum was most often used, less commonly postoperative and autopsy material, biopsy specimens, formalin-fixed paraffin-embedded samples and bronchoalveolar lavage, pleural fluid and sputum. The sensitivity of molecular diagnostics of mucormycosis in a cohort of hematological patients was 88.2%. Conclusion. The use of molecular techniques along with standard mycological methods will improve the diagnostics of mucormycosis in hematologic patients. However, prospective studies of the effectiveness of molecular methods for the diagnosis of mucormycosis of various etiologies in hematological patients, including children, using bronchoalveolar lavage (BAL) and cerebrospinal fluid (CSF) are needed.
Highlights
In recent decades the incidence of mucormycosis has been increasing due to the growth of the number of severely immunocompromised patients
In a systematic search in the PubMed, Google Scholar databases we found 38 articles on molecular methods for the detection and identification of mucormycetes in various substrates
The analysis did not include review articles, abstracts for conferences, descriptions of clinical cases, as well as articles where there were no characteristics of the background states of patients with mucormycosis, or the research results combined for various cohorts of patients, including non-hematological patients
Summary
In recent decades the incidence of mucormycosis has been increasing due to the growth of the number of severely immunocompromised patients. Mucormycosis is mostly seen in hematological patients [1,2]. Mucormycetes are the second most common causative agents of mycoses in hematological patients after the Aspergillus spp. and the third most common infection after candidiasis and aspergillosis in recipients of allogeneic hematopoietic stem cell transplants (allo-HSCT) [3,4]. At the same time, increased frequency of mucormycosis in hematological patients was noted. An increasing incidence of mucormycosis in hematological patients can be associated with the intensification of cytostatic chemotherapy and with the use of inactive against mucormycetes voriconazole for prevention and treatment of aspergillosis [6,7,8]. Voriconazole was used in 74% of these patients for the treatment of aspergillosis
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