מתוך medicontext.co.il
WESTPORT, CT (Reuters Health) – Testing febrile patients with neutropenia and cancer for fungal infection using nested polymerase chain reaction (PCR) allows early institution of appropriate antifungal therapy, investigators in Taiwan report. This strategy appears to reduce mortality rates in these patients.
Dr. Ming-Tsan Lin and colleagues at Changhua Christian Hospital in Changhua, designed a nested PCR system to detect eight species of Candida, two species of Aspergillus, and one each of Trichosporon and Cryptococcus. They then investigated 83 episodes of fever and neutropenia in 42 patients.
As reported in Clinical Infectious Diseases for November 15, patients ranged in age from 11 months to 15 years. Each patient underwent nested PCR blood culture testing as soon as they became febrile, and a second PCR test was done if the first was positive. Treatment with amphotericin B was initiated after two consecutive positive PCR results.
In 29 episodes, Candida was identified by PCR, including 22 episodes in which blood cultures were also positive. There were also two episodes diagnosed as transient fungemia. The remaining 52 episodes were diagnosed as fever of unknown origin or a bacterial infection.
The nested PCR assay detected fungal infections 1 to 8 days earlier than did conventional blood culture, the researchers note. Dr. Lin's group estimates that mortality was 23.5% in patients with culture-proven candidemia and 29% among those with positive PCR results but negative blood cultures. The "reduced mortality rate…[was] significant in comparison with the higher mortality rate in historical case reports, 47% to 75%," they maintain.
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