TY  - JOUR
A1  - White, P. Lewis
A1  - Wiederhold, Nathan P.
A1  - Loeffler, Juergen
A1  - Najvar, Laura K.
A1  - Melchers, Willem
A1  - Herrera, Monica
A1  - Bretagne, Stephane
A1  - Wickes, Brian
A1  - Kirkpatrick, William R.
A1  - Barnes, Rosemary A.
A1  - Donnelly, J. Peter
A1  - Patterson, Thomas F.
T1  - Comparison of nonculture blood-based tests for diagnosing invasive aspergillosis in an animal model
T2  - Journal of Clinical Microbiology
N2  - The European Aspergillus PCR Initiative (EAPCRI) has provided recommendations for the PCR testing of whole blood (WB) and serum/plasma. It is important to test these recommended protocols on nonsimulated "in vivo" specimens before full clinical evaluation. The testing of an animal model of invasive aspergillosis (IA) overcomes the low incidence of disease and provides experimental design and control that is not possible in the clinical setting. Inadequate performance of the recommended protocols at this stage would require reassessment of methods before clinical trials are performed and utility assessed. The manuscript describes the performance of EAPCRI protocols in an animal model of invasive aspergillosis. Blood samples taken from a guinea pig model of IA were used for WB and serum PCR. Galactomannan and beta-D-glucan detection were evaluated, with particular focus on the timing of positivity and on the interpretation of combination testing. The overall sensitivities for WB PCR, serum PCR, galactomannan, and beta-D-glucan were 73%, 65%, 68%, and 46%, respectively. The corresponding specificities were 92%, 79%, 80%, and 100%, respectively. PCR provided the earliest indicator of IA, and increasing galactomannan and beta-D-glucan values were indicators of disease progression. The combination of WB PCR with galactomannan and beta-D-glucan proved optimal (area under the curve AUC], 0.95), and IA was confidently diagnosed or excluded. The EAPRCI-recommended PCR protocols provide performance comparable to commercial antigen tests, and clinical trials are warranted. By combining multiple tests, IA can be excluded or confirmed, highlighting the need for a combined diagnostic strategy. However, this approach must be balanced against the practicality and cost of using multiple tests.
KW  - high-risk hematology
KW  - Guinea pig model
KW  - real-time PCR
KW  - fungal disease
KW  - galactomannan
KW  - pulmonary aspergillosis
KW  - amphotericin B
KW  - Aspergillus fumigatus
KW  - beta-D-glucan
Y1  - 2016
UR  - https://opus.bibliothek.uni-wuerzburg.de/frontdoor/index/index/docId/18967
UR  - https://nbn-resolving.org/urn:nbn:de:bvb:20-opus-189674
VL  - 54
IS  - 4
ER  -