Polymerase chain reaction screening for fungemia and/or invasive fungal infections in patients with hematologic malignancies.
BACKGROUND
Invasive fungal infections (IFIs) are a life-threatening complication in patients with hematologic malignancies, mainly in acute leukemia patients, following chemotherapy. IFI incidence is increasing, and associated mortality remains high due to unreliable diagnosis. Antifungal drugs are often limited by inadequate antimicrobial spectrum and side effects. Thus, the detection of circulating fungal DNA has been advocated as a rapid, more sensitive diagnostic tool.


METHODS
Between June 01 and January 03, weekly blood samples (1,311) were screened from 193 patients undergoing intensive myelosuppressive or immunosuppressive therapy. IFI cases were classified according to European Organization for Research and Treatment of Cancer/Mycoses Study Group criteria. Fungal DNA was extracted from whole blood and amplified using polymerase chain reaction (PCR) published primers that bind to the conserved regions of the fungal 18S rRNA gene sequence. In our study, two or more consecutive positive samples were always associated with fungal disease.


RESULTS
PCR screening predicted the development of IFI to be 17 days (median). This test had a specificity of 91.1% and a sensitivity of 75%. IFI incidence was 7.8%.


CONCLUSIONS
Therefore, our results confirm the potential usefulness of PCR serial screening and the clinical applicability in everyday routine. PCR screening offers a noninvasive repeatable aid to the diagnosis of IFI.
Ribeiro
Patrícia
P
Department of Hematology, Hospital dos Capuchos, Lisbon, Portugal. patriciamribeiro@sapo.pt
Costa
Fátima
F
Monteiro
Alexandra
A
Caldas
Joana
J
Silva
Madalena
M
Ferreira
Gilda
G
Veiga
Joana
J
Sousa
Manuel O
MO
Viegas
Maria P
MP
Santos
Ester
E
Gonçalves
António J
AJ
Sousa
Aida B
AB
D000293:Adolescent; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000276:immunology / Q000627:therapeutic use; D004271:DNA, Fungal / Q000097:blood; D003955:Diagnostic Tests, Routine; D005260:Female; D016469:Fungemia / Q000175:diagnosis* / Q000209:etiology / Q000517:prevention & control; D019337:Hematologic Neoplasms / Q000188:drug therapy* / Q000821:virology; D006801:Humans; D016867:Immunocompromised Host / Q000187:drug effects; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D009503:Neutropenia / Q000209:etiology; D016133:Polymerase Chain Reaction; D011446:Prospective Studies
D000970:Antineoplastic Agents; D004271:DNA, Fungal