Performance of Blood culture, β -D-glucan and PCR for Diagnosis of Systemic Fungal Infection in Cancer Patients

Mohammed Elshaer,Ahmad Elewa,Noha El-Mashad,Amina Abd El Aal

doi:10.12691/ajmr-7-3-1

Abstract

Background and purpose: The incidence of systemic fungal infection has increased considerably in recent years. It is of greater concern because they are often misdiagnosed. The study aimed to assess the diagnostic performance of ELISA and Polymerase chain reaction versus the gold standard blood culture in diagnosing systemic fungal infection. Materials and Methods: The study included 70 cancer patients at the Mansoura University Oncology Center clinically suspected to suffer from systemic fungal infection. Blood samples were subjected to automated blood culture, antigen detection by ELISA and PCR for fungal DNA. Results: Considering the different methods used for diagnosis of systemic fungal infection, 19 patients were positive by blood culture, 36 patients were positive by ELISA and 32 patients were positive by PCR. Both β -D-glucan and PCR exhibited higher sensitivity, specificity and accuracy with higher NPV than PPV compared to the gold standard blood culture which lacks the desired sensitivity and specificity. Conclusion: Rapid diagnostic techniques such as ELISA and PCR offer an accurate and reproducible tool for early diagnosis and treatment of fungal pathogens.

Highlights

Systemic fungal infection is a serious cause of mortality and morbidity in immunocompromised patients, including hematological malignancy, transplant recipients, and those under intensive care or chemotherapy
New diagnostic approaches have been developed based on nonculture based methods, including antigen-based assays, metabolite detection and molecular detection of fungal DNA from body fluid samples which may allow early diagnosis and treatment of fungal infection [3]. 1,3- β -D-glucan (BDG) is a component of the fungal cell wall that presents in many fungal species and it should be considered as a pan-fungal detection method and a good indicator of systemic fungal infection, if detectable in blood or other normally sterile body fluids [4]
Over a period of one year, blood samples were collected from 70 cancer patients with suspected systemic fungal infection

Summary

Introduction

Systemic fungal infection is a serious cause of mortality and morbidity in immunocompromised patients, including hematological malignancy, transplant recipients, and those under intensive care or chemotherapy. Molecular techniques, including DNA sequencing, microarrays, FISH and polymerase chain reaction (PCR), have been used for broad-range molecular detection assays These techniques have become more available in many laboratories; allow identification of rare fungal species with a large database [5]. Results: Considering the different methods used for diagnosis of systemic fungal infection, 19 patients were positive by blood culture, 36 patients were positive by ELISA and 32 patients were positive by PCR. Both β -D-glucan and PCR exhibited higher sensitivity, specificity and accuracy with higher NPV than PPV compared to the gold standard blood culture which lacks the desired sensitivity and specificity. Conclusion: Rapid diagnostic techniques such as ELISA and PCR offer an accurate and reproducible tool for early diagnosis and treatment of fungal pathogens

Objectives

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Conclusion