Evaluation of an Aspergillus PCR assay in Cerebrospinal Fluid Samples of Immunocompromised Patients to Detect Cerebral Aspergillosis

Ref ID: 18674

Author:

M. Reinwald, MD (Doctor of Medicine) – Resident1, M. Hummel, MD – Resident 1, B. Spiess, PhD – Senior Fellow 1, M. Duerken, MD – Senior Lecturer 1, H. Bertz, MD – Professor 2, M. Barreto-Miranda, MD – Resident 1, W. K. Hofmann, MD – Professor 1, D. B

Author address:

1Mannheim Univ. Hosp., Mannheim, Germany, 2Freiburg Univ. Hosp., Freiburg, Germany.

Full conference title:

52nd Annual ICAAC

Date: 9 September 2014

Abstract:

Background: Cerebral invasive aspergillosis (cIA) is an often fatal complication of invasive aspergillosis (IA) in immunocompromised patients. Obtaining a valid diagnosis is rarely accomplished as biopsies are impeded by underlying neutropenia and low platelet counts. Results from cerebrospinal fluid (CSF) cultures or galactomannan usually yield negative results thus underlining the need for improving diagnostics. Therefore the performance of an established Aspergillus-specific nested PCR assay in CSF samples of patients with suspicion of cIA was retrospectively evaluated. Methods: We investigated 133 CSF samples of 63 immunocompromised patients for whom cerebral aspergillosis was suspected. Twentythree CSF samples were not evaluable due to insufficient sample remaining thus 110 evaluable samples from 53 patients were included in the analysis. Eight patients were identified as having proven (n=8) cerebral aspergillosis. No patient was classified as having probable disease, the remaining 45 patients were classified as having either possible (n=19) or no cIA (n=26). Results: PCR positivity in CSF samples was observed for 8 of 8 proven, and 6 of 45 possible and no IA patients yielding sensitivity/specificity rates of 1.0 (95%CI 0.68-1) / 0.87 (95%CI 0.74-0.94. The positive/negative likelihood ratio were found to be 7.5/0, thus leading to a diagnostic odds ratio of >200. Conclusions: In our retrospective analysis of a large number of CSF samples from immunocompromised patients at risk of cIA a high sensitivity of a nested PCR assay was observed. Based on our data, PCR testing of CSF samples is suggested for patients with suspected cIA, especially for those whose clinical condition forbids invasive procedures, as a positive PCR result makes the presence of cIA highly likely based on the tests diagnostic odds ratio.

Abstract Number: M-1704

Conference Year: 2012

Link to conference website: NULL

New link: NULL

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