Spiess Birgit, Buchheidt Dieter, Baust Corinna, Skladny Heyko, Seifarth Wolfgang, Zeilfelder Udo, Leib-Mösch Christine, Mörz Handan, Hehlmann Rüdiger
III Medizinische Klinik, Universitätsklinikum Mannheim, University of Heidelberg, D-68305 Mannheim, Germany.
J Clin Microbiol. 2003 May;41(5):1811-8. doi: 10.1128/JCM.41.5.1811-1818.2003.
The increasing incidence of invasive aspergillosis, a life-threatening infection in immunocompromised patients, emphasizes the need to improve the diagnostic tools for this disease. We established a LightCycler-based real-time PCR assay to detect and quantify rapidly, specifically, and sensitively Aspergillus fumigatus DNA in both bronchoalveolar lavage (BAL) and blood samples from high-risk patients. The primers and hybridization probes were derived from an A. fumigatus-specific sequence of the mitochondrial cytochrome b gene. The assay is linear in the range between 13.2 fg and 1.3 ng of A. fumigatus DNA, corresponding to 3 to 300,000 CFU per ml of BAL fluid or blood. No cross-amplification was observed with human DNA or with the DNA of fungal or bacterial pathogens. For clinical evaluation we investigated 10 BAL samples from nine neutropenic patients with malignant hematological diseases and 12 blood samples from seven neutropenic patients with malignant hematological diseases. Additionally, we tested one blood sample and one BAL sample from each of two neutropenic patients. In order to characterize the validity of the novel PCR assay, only samples that had shown positive results by a previously described sensitive and specific nested PCR assay were tested. Twelve of 12 BAL samples and 6 of 14 blood samples gave positive results by the LightCycler PCR assay. Eight of 14 blood samples gave negative results by the novel method. The LightCycler PCR-mediated quantification of the fungal burden showed 15 to 269,018 CFU per ml of BAL sample and 298 to 104,114 CFU per ml of blood sample. Twenty of 20 BAL samples and 50 of 50 blood samples from subjects without evidence of invasive pulmonary aspergillosis (IPA) were PCR negative. Compared to a previously described nested PCR assay, these preliminary data for the novel real-time PCR assay indicate a less sensitive rate of detection of IPA in high-risk patients, but the assay may be valuable for quantification of the fungal burden in individual clinical samples.
侵袭性曲霉病在免疫受损患者中是一种危及生命的感染,其发病率不断上升,这凸显了改进该疾病诊断工具的必要性。我们建立了一种基于LightCycler的实时PCR检测方法,用于快速、特异性且灵敏地检测和定量高危患者支气管肺泡灌洗(BAL)和血液样本中的烟曲霉DNA。引物和杂交探针源自线粒体细胞色素b基因的烟曲霉特异性序列。该检测方法在13.2 fg至1.3 ng的烟曲霉DNA范围内呈线性,对应于每毫升BAL液或血液中3至300,000 CFU。未观察到与人类DNA或真菌及细菌病原体DNA的交叉扩增。为进行临床评估,我们研究了来自9例患有恶性血液系统疾病的中性粒细胞减少患者的10份BAL样本以及来自7例患有恶性血液系统疾病的中性粒细胞减少患者的12份血液样本。此外,我们还检测了2例中性粒细胞减少患者每人的1份血液样本和1份BAL样本。为了表征新型PCR检测方法的有效性,仅对先前描述的灵敏且特异的巢式PCR检测方法显示为阳性结果的样本进行检测。12份BAL样本中的12份以及14份血液样本中的6份通过LightCycler PCR检测呈阳性结果。14份血液样本中的8份通过该新方法检测为阴性结果。LightCycler PCR介导的真菌负荷定量显示,每毫升BAL样本中为15至269,018 CFU,每毫升血液样本中为298至104,114 CFU。来自无侵袭性肺曲霉病(IPA)证据的受试者的20份BAL样本和50份血液样本的PCR检测均为阴性。与先前描述的巢式PCR检测方法相比,这些关于新型实时PCR检测方法的初步数据表明,高危患者中IPA的检测敏感性较低,但该检测方法对于定量单个临床样本中的真菌负荷可能具有价值。