Diagnosis of Fungal Infections: A Systematic Review and Meta-Analysis Supporting ATS Clinical Practice Guideline.
Ann Am Thorac Soc. 2019 Jun 20;:
Authors: Haydour Q, Hage CA, Carmona-Porquera EM, Epelbaum O, Evans SE, Gabe LM, Knox KS, Kolls JK, Wengenack NL, Prokop LJ, Limper AH, Murad MH
RATIONALE: Prompt diagnosis of invasive fungal infections (IFI) is important because of the associated morbidity and mortality; however, diagnosis is challenging because of the nonspecific symptoms and radiographic findings.
OBJECTIVE: To conduct a systematic review and meta-analysis of studies that evaluated the diagnostic accuracy of serum and BAL Bronchoalveolar lavage (BAL) galactomannan (GM) and serum or BAL Polymerase chain reaction (PCR) in patients with suspected invasive aspergillosis (IA); beta-D-glucan (BDG) in critically ill patients at risk for candidiasis or candidemia, and serology testing and antigen detection in patients with endemic mycoses (histoplasmosis, blastomycosis, and coccidioidomycosis).
METHODS: Studies were selected and appraised by pairs of reviewers. Bivariate random effects meta-analysis was used to generate pooled sensitivity, specificity and diagnostic likelihood ratios.
RESULTS: Serum GM in patients with impaired immunity suspected of having IA had sensitivity of 0.71 (CI: 0.64-0.78) and specificity of 0.89 (CI: 0.84-0.92). A cut-off of 1 optical density index yielded optimal sensitivity and specificity. BAL GM in patients with impaired immunity suspected of having IA had sensitivity of 0.84 (CI: 0.73-0.91) and specificity of 0.88 (CI: 0.81-0.91). Serum or whole blood PCR in immunocompromised patients with suspected IA had sensitivity of 0.81 (0.73-0.86) and specificity of 0.79 (0.68-0.86). BAL PCR in patients at high risk for IA had high sensitivity of 0.90 (0.77-0.96) and specificity of 0.96 (0.93-0.98) for diagnosing IA. BDG assay in ICU patients at risk for invasive candidiasis or candidemia had sensitivity of 0.81 (0.74, 0.86) and specificity of 0.60 (0.49, 0.71). Data on diagnostic accuracy of antigen detection and serology testing for endemic mycoses were limited and heterogeneous (varied according to test, patient immunity and suspected endemic disease).
CONCLUSIONS: The diagnosis of invasive fungal infections remains a challenge. Various serum and BAL markers can aid in diagnosis. This evidence supports the development of clinical practice recommendations by ATS.
PMID: 31219341 [PubMed - as supplied by publisher]