Aspergillus Polymerase Chain Reaction: Systematic Review of Evidence for Clinical Use in Comparison With Antigen Testing
AuthorWhite, PL; Wingard, JR; Bretagne, S; Loeffler, J; Patterson, TF; Slavin, MA; Barnes, RA; Pappas, PG; Donnelly, JP
Source TitleClinical Infectious Diseases
PublisherOXFORD UNIV PRESS INC
University of Melbourne Author/sSlavin, Monica
Document TypeJournal Article
CitationsWhite, P. L., Wingard, J. R., Bretagne, S., Loeffler, 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), pp.1293-1303. https://doi.org/10.1093/cid/civ507.
Access StatusOpen Access
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.
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