Aspergillus Polymerase Chain Reaction—An Update on Technical Recommendations, Clinical Applications, and Justification for Inclusion in the Second Revision of the EORTC/MSGERC Definitions of Invasive Fungal Disease

Abstract

Aspergillus polymerase chain reaction testing of blood and respiratory samples has recently been included in the second revision of the EORTC/MSGERC definitions for classifying invasive fungal disease. This is a result of considerable efforts to standardize methodology, the availability of commercial assays and external quality control programs, and additional clinical validation. This supporting article provides both clinical and technical justifications for its inclusion while also summarizing recent advances and likely future developments in the molecular diagnosis of invasive aspergillosis.

COVID-19-Associated Pulmonary Aspergillosis, Fungemia, and Pneumocystosis in the Intensive Care Unit: a Retrospective Multicenter Observational Cohort during the First French Pandemic Wave

“…GM was detected using Platelia Aspergillus Ag assay (Bio-Rad). Nucleic acid detection was performed locally using quantitative PCR (qPCR) with no restriction on the target (panfungal or germ specific), or the use of commercial or in-house assays, providing they comply with technical rules ( 45 ). Serum (1→3)-β- d -glucan (BDG) was detected using the Fungitell kit (Associates of Cape Cod) with a positivity threshold of >80 pg/ml.…”

Noninvasive Testing and Surrogate Markers in Invasive Fungal Diseases

“…Availability of Aspergillus PCR testing in the United States remains limited; PCR is performed in reference laboratories only (although Aspergillus PCR testing is commercially available in Europe) [ 90 ]. The reported performance characteristics of PCR vary given the different technologies, cycle thresholds for positivity, microbial targets, and study populations that have been assessed [ 91 ]. A meta-analysis evaluating 25 studies found a pooled sensitivity and specificity of 84% and 76%, respectively [ 92 ].…”

Invasive aspergillosis in liver transplant recipients

“…Specificity (98.0%) was similar to that of PCR (96.6%) and slightly superior to that of GM antigen test (91.5%) 168 . Sensitivity (81.8%) was inferior to that of PCR (95.5%) but better than that of GM antigen test (77.3%) 143 . In combination with PCR, it provided both 100% sensitivity and 100% specificity 143 .…”