title: Aspergillus Polymerase Chain Reaction: Systematic Review of Evidence for Clinical Use in Comparison With Antigen Testing.
abstract: 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.
authors.affiliation: Public Health Wales, Microbiology Cardiff, United Kingdom.
authors.forename: P Lewis
authors.initials: PL
authors.lastname: White
authors.affiliation: University of Florida Health, Gainsville.
authors.forename: John R
authors.initials: JR
authors.lastname: Wingard
authors.affiliation: Paris Diderot University, Saint Louis Hospital-AP-HP, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Bretagne
authors.affiliation: Wuerzburg University, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Löffler
authors.affiliation: University of Texas Health Science Center and South Texas Veterans Health Care System, San Antonio.
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Patterson
authors.affiliation: Peter MacCallum Cancer Centre, University of Melbourne, Australia.
authors.forename: Monica A
authors.initials: MA
authors.lastname: Slavin
authors.affiliation: Infection, Immunity and Biochemistry, Cardiff University, United Kingdom.
authors.forename: Rosemary A
authors.initials: RA
authors.lastname: Barnes
authors.affiliation: University of Alabama at Birmingham.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Pappas
authors.affiliation: Radboud University Medical Centre, Nijmegen, The Netherlands.
authors.forename: J Peter
authors.initials: JP
authors.lastname: Donnelly
mesh_terms: D000946:Antigens, Fungal / Q000032:analysis*; D001228:Aspergillosis / Q000175:diagnosis; D001230:Aspergillus / Q000235:genetics* / Q000276:immunology / Q000302:isolation & purification*; D005690:Galactose / Q000031:analogs & derivatives; D006801:Humans; D007124:Immunoenzyme Techniques / Q000706:statistics & numerical data; D008351:Mannans / Q000032:analysis; D016133:Polymerase Chain Reaction / Q000592:standards / Q000706:statistics & numerical data; D011786:Quality Control; D012680:Sensitivity and Specificity; D047071:beta-Glucans / Q000032:analysis
chemical_list: D000946:Antigens, Fungal; D008351:Mannans; D047071:beta-Glucans; C012990:galactomannan; D005690:Galactose
keywords: Aspergillus; PCR; aspergillosis; galactomannan; β-d-glucan