Development of Novel Real-Time PCR Assays for Detection and[1]
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JOURNALOFCLINICALMICROBIOLOGY,Mar.2007,p.906–914Vol.45,No.3
0095-1137/07/$08.00ϩ0doi:10.1128/JCM.01344-06
Copyright©2007,AmericanSocietyforMicrobiology.AllRightsReserved.
DevelopmentofNovelReal-TimePCRAssaysforDetectionand
DifferentiationofElevenMedicallyImportantAspergillusand
CandidaSpeciesinClinicalSpecimensᰔ
ClaudiaSchabereiter-Gurtner,*BrigitteSelitsch,ManfredL.Rotter,
AlexanderM.Hirschl,andBirgitWillinger
DepartmentofClinicalMicrobiology,InstituteofHygieneandMedicalMicrobiology,MedicalUniversityofVienna,Vienna,Austria
Received30June2006/Returnedformodification8August2006/Accepted13January2007
Inthepresentstudy,novelreal-timePCRassaystargetingthefungalITS2regionweredevelopedforthe
detectionanddifferentiationofmedicallyimportantAspergillusspecies(Aspergillusfumigatus,Aspergillus
flavus,Aspergillusnidulans,Aspergillusniger,andAspergillusterreus)andCandidaspecies(Candidaalbicans,
Candidadubliniensis,Candidaglabrata,Candidakrusei,Candidaparapsilosis,andCandidatropicalis)using
aLightCyclerinstrument.Thecombinationofagroup-specificandauniversalprimerwithfiveAspergillus
orsixCandidaspecies-specificbiprobesinonereactionmixturefacilitatedrapidscreeningandspecies
differentiationbythecharacteristicpeakmeltingtemperaturesofthebiprobes.Bothassayscanbe
performedeitherassingleassaysorsimultaneouslyinthesameLightCyclerrun.Theanalyticalsensitivity
usingpureculturesandEDTA-anticoagulatedblood,cerebrospinalfluid(CSF),andtissuesamplesspiked
withA.fumigatusandC.albicanscellsuspensionswasshowntobeatleast1CFUperPCR,corresponding
to5to10CFU/mlbloodand10CFU/200lCSFor0.02gtissue.Toassesstheclinicalapplicability,26
respiratorysamples,4tissuesamplesfromthemaxillarysinus,and1bloodsamplewereretrospectively
testedandreal-timePCRresultswerecomparedwithresultsfromculture,histology,oragalactomannan
enzyme-linkedimmunosorbentassay(ELISA).Twentysamples(64.5%)werebothculturepositiveand
positivebyreal-timePCR.Sixsamples(19.4%)showednogrowthoffungibutwerepositivebyreal-time
PCR.However,allofthetissuesampleswerepositivebybothPCRandhistology.Thebloodsample
showednogrowthofAspergillus,butaspergillosiswasconfirmedbypositivegalactomannanELISA,
histology,andPCRresults.Theremainingsamples(16.1%)werecultureandPCRnegative;also,noother
signsindicatingfungalinfectionwereobserved.OurdatasuggestthattheAspergillusandCandidaassays
maybeappropriateforuseinclinicallaboratoriesassimpleandrapidscreeningtestsforthemost
frequentlyencounteredAspergillusandCandidaspeciesandmightbecomeanimportanttoolintheearly
diagnosisoffungalinfectionsinthefuture.
Invasivefungalinfectionsareincreasinglyrecognizedasa
primarycauseofmorbidityandmortality,especiallyinimmu-
nocompromisedpatients.Thefrequencyofnosocomialcandi-
demiahasincreased10-foldduringthepasttwodecades(3).
Candidaalbicans,formerlythemostimportantspecies,isstill
theonewhichmostoftencausesdisease.However,otherspe-
ciesthanC.albicans,inparticular,Candidaglabrata,butalso
Candidatropicalis,Candidakrusei,andCandidaparapsilosis,
havegainedgreatersignificanceandmustnotbeoverlooked
(15,31).Theprevalenceofcandidiasisandtheincreasein
Candidabeingresistanttopolyeneandazoledrugshavemade
rapidspeciesdifferentiationmandatory(29,31).Therehas
beenalessstriking,thoughalsosubstantial,increaseinthe
incidenceofinvasiveaspergillosis(IA)(27).Invasiveaspergil-
losisismainlycausedbyAspergillusfumigatus,followedby
AspergillusflavusandAspergillusterreus.Otherspecies,suchas
Aspergillusnidulans,Aspergillusniger,andAspergillusustus,are
rarelyfoundindiagnosingIA.
Thedefiniteandrapiddiagnosisofinvasivefungalinfectionsisdifficultduetothelackofsensitivetestmethods.Therefore,
effortstoimprovediagnosisareongoingandneedtobefurther
intensified.Althoughprovingthepresenceofinfectionbyhis-
tologyandcultureremainsthecornerstoneofdiagnosis,non-
culture-basedmethodsarebeingdevelopedtoallowearlyde-
tection.Amongthemostpromisingapproachesarethedetection
offungalantigensandPCR(2,4,42).Theresultsofsome
studiessuggestthatacombinationoftheAspergillusgalacto-
mannanenzyme-linkedimmunosorbentassay(GM-ELISA)
andreal-timePCRmayprovideimproveddiagnosisofinvasive
aspergillosis(5,7,20,35).
Nevertheless,notonlythedetectionoffungi,butalsotheir
identification,whichcanbeobtainedonlybyPCRorculture,
isimportantfortheoptimalchoiceofantifungalsandduration
oftherapy.AvarietyofPCRassaysbasedonthedetectionof
fungalDNAinsterilehumanbodyfluidsortissuesamplesto
allowearlydiagnosisoffungalinfectionsandtoimprovethe
survivalrateofpatientssufferingfrominvasiveinfectionshas
beendescribed.However,incontrasttotheGM-ELISA,none
ofthedevelopedPCRassayshavebeenstandardized,resulting
indivergingresults.Ingeneral,theintroductionofreal-time
PCRtechnologyinthedetectionoffungalinfectionshasin-