Clinical utility of a panfungal polymerase chain reaction assay for invasive fungal diseases in patients with haematologic disorders.
Clinical utility of a panfungal polymerase chain reaction assay for invasive fungal diseases in patients with haematologic disorders.
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全真菌聚合酶链反应测定在血液系统疾病患者侵袭性真菌病中的临床应用。
DOI：
10.1111/ejh.12078
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发表时间：
2013
期刊：
影响因子：
--
通讯作者：
Katayama N.
中科院分区：
文献类型：
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作者：
Sugawara Y;Nakase K;Nakamura A;Ohishi K;Sugimoto Y;Fujieda A;Monma F;Suzuki K;Masuya M;Matsushima Y;Wada H;Nobori T;Katayama N.
侵袭性真菌病（IFD）是血液系统疾病患者的危及生命的事件，并且病原体谱持续扩大。本研究旨在评价泛真菌聚合酶链反应（PCR）的临床应用价值方法我们前瞻性分析了2007年4月至2010年10月期间在我院接受治疗的51例IFD高危血液病患者的64次风险发作的273份连续血液样本。64次（35.3%）。根据欧洲癌症/真菌病研究和治疗组织修订的标准，在14次发作中记录了IFD（21.9%，9例可能IFD和5例可能IFD）。PCR在所有这14次发作中均为阳性，50次发作中有4次无IFD类别。本方法的敏感性、特异性、阳性预测值和阴性预测值分别为100%、92%、78%和100%。PCR结果显示，有相当数量的真菌（44.4%）为阳性，但这些真菌的数量远低于曲霉和真菌。Cunninghamellaspecies，Aspergillus ustus，Fusariumspecies，Scedosporium apiospermum，Rhodotorulaspecies和Rhizopusspecies的分子诊断有助于选择合适的treatments.ConclusionsOur泛真菌PCR方法允许高灵敏度和特异性的检测和鉴定广谱真菌病原体，这为管理IFDs提供了不可或缺的信息，尤其是血液病高危患者抗真菌治疗期间的难治性或突破性IFD。
ObjectivesInvasive fungal diseases (IFDs) are life‐threatening events in patients with haematologic disorders, and the spectrum of the aetiological pathogens continues to expand. This study aimed to evaluate the clinical utility of a panfungal polymerase chain reaction (PCR) assay for the management of IFDs in such patients.MethodsWe prospectively analysed 273 consecutive blood samples from 64 risk episodes in 51 patients with haematologic disorders at high risk for IFD who were treated at our hospital between April 2007 and October 2010.ResultsPCR‐positive results were obtained in 18 of 64 risk episodes (35.3%). IFD was documented in 14 episodes (21.9%, 9 probable IFDs and 5 possible IFDs) according to the revised criteria of the European Organization for Research and Treatment of Cancer/Mycoses Study Group. PCR was positive in all of these 14 episodes, and in 4 of the 50 episodes with no IFD category. Sensitivity, specificity, positive predictive value, and negative predictive value of our assay were 100%, 92%, 78% and 100% respectively. A considerable number of fungi (44.4%) that are less common thanAspergillusandCandidaspecies were positive by PCR. Molecular diagnoses ofCunninghamellaspecies,Aspergillus ustus,Fusariumspecies,Scedosporium apiospermum,Rhodotorulaspecies andRhizopusspecies were beneficial in selecting suitable treatments.ConclusionsOur panfungal PCR approach allows for the highly sensitive and specific detection and identification of a wide spectrum of fungal pathogens, which provides indispensable information for managing IFDs, especially refractory or breakthrough IFDs during antifungal therapy in high‐risk patients with haematologic disorders.