Aspergillus Polymerase Chain Reaction: Systematic Review of Evidence for Clinical Use in Comparison With Antigen Testing
Publication year
2015Source
Clinical Infectious Diseases, 61, 8, (2015), pp. 1293-303ISSN
Publication type
Article / Letter to editor

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Organization
Haematology
Journal title
Clinical Infectious Diseases
Volume
vol. 61
Issue
iss. 8
Page start
p. 1293
Page end
p. 303
Subject
Radboudumc 5: Inflammatory diseases RIMLS: Radboud Institute for Molecular Life SciencesAbstract
BACKGROUND: Aspergillus polymerase chain reaction (PCR) was excluded from the European Organisation for the Research and Treatment of Cancer/Mycoses Study Group (EORTC/MSG) definitions of invasive fungal disease because of limited standardization and validation. The definitions are being revised. METHODS: A systematic literature review was performed to identify analytical and clinical information available on inclusion of galactomannan enzyme immunoassay (GM-EIA) (2002) and beta-d-glucan (2008), providing a minimal threshold when considering PCR. Categorical parameters and statistical performance were compared. RESULTS: When incorporated, GM-EIA and beta-d-glucan sensitivities and specificities for diagnosing invasive aspergillosis were 81.6% and 91.6%, and 76.9% and 89.4%, respectively. Aspergillus PCR has similar sensitivity and specificity (76.8%-88.0% and 75.0%-94.5%, respectively) and comparable utility. Methodological recommendations and commercial PCR assays assist standardization. Although all tests have limitations, currently, PCR is the only test with independent quality control. CONCLUSIONS: We propose that there is sufficient evidence that is at least equivalent to that used to include GM-EIA and beta-d-glucan testing, and that PCR is now mature enough for inclusion in the EORTC/MSG definitions.
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