Abstract
Invasive aspergillosis (IA) is a life-threatening infection in immunocompromised patients. Early diagnosis is essential to improve survival. Since the 1990s, attempts for PCR-based diagnosis of IA were made. Progress in the standardization of methods enabled the development of commercially available Aspergillus PCR assays in the last few years. Up to now, the clinical value of only a few commercial assays was investigated more extensively in large cohort studies. Most often, respiratory secretions such as bronchoalveolar lavage (BAL) were investigated, but some studies also included serum samples from high-risk patients. The data indicate that Aspergillus PCR, most likely in combination with galactomannan detection, has the potential for early and reliable diagnosis of IA including azole resistance markers. With the broad implementation of this technique in routine diagnosis and incorporation into patient care pathways, it is conceivable that an improvement in management of IA and subsequently patient outcome could occur.
Highlights
Aspergillosis, which is defined as an infection or disease caused by fungi of the genus Aspergillus, mainly affects immunocompromised and critically ill patients and invasive disease is associated with high mortality
Since 2006, major progress was made in the standardization of PCR assays for the detection of Aspergillus-DNA in clinical samples by the European Aspergillus PCR Initiative (EAPCRI) Working Group of the International Society of Human and Animal Mycoses (ISHAM; White et al, 2011a)
In a larger study (Orsi et al, 2015), the MycAssay Aspergillus R was compared with galactomannan and culture in bronchoalveolar lavage (BAL) samples from 41 patients (44 samples) at risk for infection along with assays for the detection of Pneumocystis jirovecii
Summary
Aspergillosis, which is defined as an infection or disease caused by fungi of the genus Aspergillus, mainly affects immunocompromised and critically ill patients and invasive disease is associated with high mortality. The global emergence of infections with azole-resistant Aspergillus fumigatus (Steinmann et al, 2015; Verweij et al, 2016), associated with therapeutic failure, strengthened the need for rapid and reliable diagnostic methods. The conventional diagnosis of Aspergillus infections is based on the presence of risk factors, radiological features, and microbiological results, i.e., histopathology and/or culture of Aspergillus spp. A milestone was the standardization of the classification of disease based on probability of aspergillosis [i.e., proven, probable, or possible invasive fungal disease according to the definitions of the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study
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