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Aspergillus polymerase chain reaction: systematic review of evidence for clinical use in comparison with antigen testing

White, P. Lewis, Wingard, John R., Bretagne, Stephane, Loeffler, Juergen, Patterson, Thomas F., Slavin, Monica A., Barnes, Rosemary Ann, Pappas, Peter G. and Donnelly, J. Peter 2015. Aspergillus polymerase chain reaction: systematic review of evidence for clinical use in comparison with antigen testing. Clinical Infectious Diseases 61 (8) , pp. 1293-1303. 10.1093/cid/civ507

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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.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Subjects: R Medicine > R Medicine (General)
Additional Information: First published online 25 June 2015
Publisher: University of Chicago Press
ISSN: 1058-4838
Date of First Compliant Deposit: 13 March 2019
Date of Acceptance: 13 June 2015
Last Modified: 13 Nov 2019 15:28

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