Badiee Parisa, Kordbacheh Parivash, Alborzi Abdolvahab, Malekhoseini Seyedali, Zeini Farideh, Mirhendi Hosein, Mahmoodi Mahmood
Prof. Alborzi Clinical Microbiology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
Liver Transpl. 2007 Jul;13(7):1011-6. doi: 10.1002/lt.21175.
Invasive fungal infections after liver transplantation (LT) have resulted in high mortality and potentially fatal complications. This study was undertaken to determine the accuracy of the panfungal polymerase chain reaction enzyme link immunosorbent assay (PCR-ELISA) method in early diagnosis of invasive fungal infections in liver transplant recipients (LTRs). A total of 48 liver recipients (cadaver donors) were followed for fungal infections for a period of at least 6 months. All clinical samples were cultured and a direct microscopic examination was performed. Blood samples were cultured by bedside inoculation onto BACTEC medium. Whole blood specimens were collected prospectively once per week and were evaluated for any invasive fungal infections by panfungal PCR and PCR-ELISA. Among 48 transplant recipients between September 2004 and January 2006 (22 females, 28 males, mean age = 34.4 yr), 40 recipients (83.3%) had Candida colonization in different sites of their body before LT. In proven and probable recipients for panfungal PCR-ELISA, the sensitivity, specificity, and positive and negative predictive values were 83.3%, 91.7%, 76.9%, and 94.3%, respectively. By PCR assay, fungal infections were diagnosed in 10 recipients (20.8%). The mean interval time from transplantation to development of fungal infection was 61.4 days (range, 20-150 days) and time of infection in blood before any clinical signs was 7-70 days with mean of 21.4 days. The etiologic agents were Candida albicans (9 cases) and Aspergillus fumigatus (1 case). Use of PCR-ELISA in LTRs may not only improve the ability of early diagnosis of invasive fungal infections (IFIs) when positive results are obtained, but also would provide more confidence to exclude a diagnosis of IFIs when negative results are obtained.
肝移植（LT）后侵袭性真菌感染导致了高死亡率和潜在的致命并发症。本研究旨在确定泛真菌聚合酶链反应酶联免疫吸附测定（PCR-ELISA）方法在肝移植受者（LTRs）侵袭性真菌感染早期诊断中的准确性。共对48例肝移植受者（尸体供体）进行了至少6个月的真菌感染随访。对所有临床样本进行培养并进行直接显微镜检查。血样通过床边接种到BACTEC培养基上进行培养。前瞻性地每周采集一次全血标本，通过泛真菌PCR和PCR-ELISA评估是否存在任何侵袭性真菌感染。在2004年9月至2006年1月期间的48例移植受者中（22例女性，28例男性，平均年龄=34.4岁），40例受者（83.3%）在肝移植前身体不同部位有念珠菌定植。在经证实和可能感染泛真菌的PCR-ELISA受者中，敏感性、特异性、阳性预测值和阴性预测值分别为83.3%、91.7%、76.9%和94.3%。通过PCR检测，在10例受者（20.8%）中诊断出真菌感染。从移植到发生真菌感染的平均间隔时间为61.4天（范围为20 - 150天），在出现任何临床症状之前血液中感染的时间为7 - 70天，平均为21.4天。病原体为白色念珠菌（9例）和烟曲霉（1例）。在LTRs中使用PCR-ELISA不仅在获得阳性结果时可提高侵袭性真菌感染（IFI）的早期诊断能力，而且在获得阴性结果时也能更有把握地排除IFI诊断。
