Aspergillus Polymerase Chain Reaction: Systematic Review of Evidence for Clinical Use in Comparison with Antigen Testing

P. Lewis White, John R. Wingard, Stéphane Bretagne, Jürgen Löffler, Thomas F. Patterson, Monica A. Slavin, Rosemary A. Barnes, Peter G. Pappas, J. Peter Donnelly

Research output: Contribution to journalArticle

98 Scopus citations

Abstract

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 β-d-glucan (2008), providing a minimal threshold when considering PCR. Categorical parameters and statistical performance were compared. Results. When incorporated, GM-EIA and β-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 β-d-glucan testing, and that PCR is now mature enough for inclusion in the EORTC/MSG definitions.

Original languageEnglish (US)
Pages (from-to)1293-1303
Number of pages11
JournalClinical Infectious Diseases
Volume61
Issue number8
DOIs
StatePublished - Oct 15 2015

Keywords

  • Aspergillosis
  • Aspergillus
  • Galactomannan
  • PCR
  • β-D-glucan

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

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    White, P. L., Wingard, J. R., Bretagne, S., Löffler, J., Patterson, T. F., Slavin, M. A., Barnes, R. A., Pappas, P. G., & Donnelly, J. P. (2015). Aspergillus Polymerase Chain Reaction: Systematic Review of Evidence for Clinical Use in Comparison with Antigen Testing. Clinical Infectious Diseases, 61(8), 1293-1303. https://doi.org/10.1093/cid/civ507