title: Evaluation of multiplex PCR in first episodes of febrile neutropenia as a tool to improve early yeast diagnosis in leukemic/preleukemic patients.
abstract: In febrile neutropenic onco-hematological patients, delayed microbiological diagnosis leads to an increase in morbidity and mortality. Identification of the microorganism changes antibiotic therapy in more than half of cases; however, in only 20-30 % of such cases pathogen isolation is achieved. This study evaluates the frequency of fungus infection and its etiology in onco-hematological patients with febrile neutropenia utilizing blood cultures and non-commercial multiplex polymerase chain reaction (MT-PCR) primers. Fifty-three febrile neutropenia episodes in 35 onco-hematological patients were observed, and the results for the first unique 30 episodes are presented. Blood cultures were positive for Candida tropicalis (one case), gram-positive bacteria (two cases), and gram-negative bacteria (four cases), showing a 23.3 % microbiological isolation rate. Multiplex-PCR pan-fungal sequence was positive in 18 cases (60 %), and further sequencing identified fugal pathogens in 11 cases (Candida glabrata and Candida parapsilosis being the most common). MT-PCR pan-fungal sequence amplification was detected in 13 of 16 patients that later received antifungal treatment for clinical reasons only, while positivity was found in 5 out of 14 patients that did not receive antifungal treatment (p = 0.02). These results show that performing in-house non-commercial MT-PCR is feasible and may provide additional information about fungal infection without the need to wait for culture results. Further research is necessary to incorporate this technology into the decision-making process.
authors.affiliation: Tropical Medicine Department, Federal University of Pernambuco, Recife, Brazil, contato@conscient.med.br.
authors.forename: H
authors.initials: H
authors.lastname: Teixeira
authors.forename: L
authors.initials: L
authors.lastname: Silva
authors.forename: J J F
authors.initials: JJ
authors.lastname: Magalhães
authors.forename: C
authors.initials: C
authors.lastname: Matias
authors.forename: J F F
authors.initials: JF
authors.lastname: Magalhães
authors.forename: J M A
authors.initials: JM
authors.lastname: Lyra
authors.forename: V
authors.initials: V
authors.lastname: Magalhães
authors.forename: N
authors.initials: N
authors.lastname: Lucena-Silva
authors.forename: H R L
authors.initials: HR
authors.lastname: Melo
authors.forename: M B
authors.initials: MB
authors.lastname: Jucá
authors.forename: C A A
authors.initials: CA
authors.lastname: Brito
mesh_terms: D000328:Adult; D002175:Candida / Q000472:pathogenicity*; D002177:Candidiasis / Q000175:diagnosis*; D064147:Febrile Neutropenia / Q000382:microbiology*; D005260:Female; D006801:Humans; D007938:Leukemia / Q000382:microbiology*; D008297:Male; D008875:Middle Aged; D060885:Multiplex Polymerase Chain Reaction / Q000592:standards*