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用于新兴孢子丝菌病快速诊断的多重定量聚合酶链反应检测方法的开发与评估

Development and evaluation of a multiplex qPCR assay for rapid diagnostics of emerging sporotrichosis.

作者信息

Della Terra Paula Portella, Gonsales Fernanda Fidelis, de Carvalho Jamile Ambrósio, Hagen Ferry, Kano Rui, Bonifaz Alexandro, Camargo Zoilo Pires de, Rodrigues Anderson Messias

机构信息

Laboratory of Emerging Fungal Pathogens, Department of Microbiology, Immunology, and Parasitology, Discipline of Cellular Biology, Federal University of São Paulo (UNIFESP), São Paulo, Brazil.

Department of Medicine, Discipline of Infectious Diseases, Federal University of São Paulo (UNIFESP), São Paulo, Brazil.

出版信息

Transbound Emerg Dis. 2022 Jul;69(4):e704-e716. doi: 10.1111/tbed.14350. Epub 2021 Nov 2.

Abstract

Sporothrix schenckii and related species are the agents of human and animal sporotrichosis. Routine diagnoses using classical mycological approaches are unspecific due to overlapping phenotypes. As the frequency and prevalence of sporotrichosis increases worldwide, developing specific, sensitive and cost-effective diagnostic tools is essential to understand the distribution patterns, map-affected areas and promote specific public health strategies to mitigate future outbreaks. Polymorphisms among the β-tubulin gene were exploited to speciate S. brasiliensis, S. schenckii and S. globosa in a one-tube multiplex probe-based qPCR assay. A panel of 84 Sporothrix revealed 100% specificity (AUC = 1.000, 95% CI = 0.971-1.000, p < .0001) without cross-reacting with other medically relevant fungi, human, feline or murine DNA. Speciation via multiplex qPCR matched phylogenetic identification (Kappa = 1.0; 95% CI = 1.0-1.0; very good agreement), supporting its use as a reliable alternative to DNA sequencing. Remarkably, the lower limit of detection was 3 copies of the target for all species. As a proof of concept, we used swabs of wound exudate of 70 cats suspected of sporotrichosis to reveal an overwhelming occurrence of S. brasiliensis in 69 specimens (sensitivity = 98.57%; 95%CI: 92.3-100.0 and specificity = 100%; 95% CI = 78.2-100). In comparison to culture, qPCR showed a larger area under the curve (AUC = 0.993±0.007; 95% CI = 0.944-1.000; p < .0001; Youden's index = 0.9857), supporting that qPCR is an essential tool for accurately detect Sporothrix DNA directly from clinical samples, thus accelerating the diagnosis of sporotrichosis. Moreover, our multiplex qPCR system has the potential to increase diagnostic capacity in Sporothrix-affected areas, helping the local animal health agent or veterinarian to quickly identify and isolate new cases, which will likely benefit thousands of patients infected every year worldwide.

摘要

申克孢子丝菌及相关菌种是人和动物孢子丝菌病的病原体。由于表型重叠,使用经典真菌学方法进行常规诊断缺乏特异性。随着孢子丝菌病在全球范围内的发病率和流行率不断上升,开发特异性强、灵敏度高且经济高效的诊断工具对于了解其分布模式、绘制受影响区域以及推动制定特定的公共卫生策略以减轻未来疫情至关重要。利用β-微管蛋白基因的多态性,通过基于单管多重探针的定量聚合酶链反应(qPCR)测定法对巴西孢子丝菌、申克孢子丝菌和球形孢子丝菌进行菌种鉴定。一组84株孢子丝菌显示该方法具有100%的特异性(曲线下面积[AUC]=1.000,95%置信区间[CI]=0.971-1.000,p<.0001),且不与其他医学相关真菌、人、猫或鼠的DNA发生交叉反应。通过多重qPCR进行的菌种鉴定与系统发育鉴定结果相符(卡帕值[Kappa]=1.0;95%CI=1.0-1.0;一致性非常好),支持将其作为DNA测序的可靠替代方法。值得注意的是,所有菌种的检测下限均为3个目标拷贝。作为概念验证,我们使用了70只疑似患有孢子丝菌病的猫的伤口渗出物拭子,结果显示69个样本中巴西孢子丝菌的感染率极高(灵敏度=98.57%;95%CI:92.3-100.0,特异性=100%;95%CI=78.2-100)。与培养法相比,qPCR显示出更大的曲线下面积(AUC=0.993±0.007;95%CI=0.944-1.000;p<.0001;约登指数=0.9857),这支持qPCR是直接从临床样本中准确检测孢子丝菌DNA的重要工具,从而加快了孢子丝菌病的诊断。此外,我们的多重qPCR系统有潜力提高在孢子丝菌感染地区的诊断能力,帮助当地动物卫生机构或兽医快速识别和隔离新病例,这可能会使全球每年数千名感染者受益。

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