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Clinical utility of a panfungal polymerase chain reaction assay for invasive fungal diseases in patients with haematologic disorders
Author(s) -
Sugawara Yumiko,
Nakase Kazunori,
Nakamura Akiko,
Ohishi Kohshi,
Sugimoto Yuka,
Fujieda Atushi,
Monma Fumihiko,
Suzuki Kei,
Masuya Masahiro,
Matsushima Yoshiko,
Wada Hideo,
Nobori Tsutomu,
Katayama Naoyuki
Publication year - 2013
Publication title -
european journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 84
eISSN - 1600-0609
pISSN - 0902-4441
DOI - 10.1111/ejh.12078
Subject(s) - polymerase chain reaction , medicine , etiology , predictive value , biology , genetics , gene
Objectives Invasive fungal diseases ( IFD s) 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 IFD s in such patients. Methods We 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. Results PCR ‐positive results were obtained in 18 of 64 risk episodes (35.3%). IFD was documented in 14 episodes (21.9%, 9 probable IFD s and 5 possible IFD s) according to the revised criteria of the E uropean O rganization for R esearch and T reatment of C ancer/ M ycoses S tudy G roup. 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 than A spergillus and C andida species were positive by PCR . Molecular diagnoses of C unninghamella species, A spergillus ustus , F usarium species, S cedosporium apiospermum , R hodotorula species and R hizopus species were beneficial in selecting suitable treatments. Conclusions Our 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 IFD s, especially refractory or breakthrough IFD s during antifungal therapy in high‐risk patients with haematologic disorders.