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The diagnosis of mucormycosis by PCR in patients at risk: a systematic review and meta-analysis

Summary

This study evaluated how well PCR blood tests and tissue samples can diagnose a serious fungal infection called mucormycosis. Researchers analyzed 30 previous studies and found that PCR testing works very well, especially on respiratory fluid samples. Blood tests showed good accuracy too and could be useful for screening high-risk patients without requiring invasive procedures. The findings suggest PCR should become a standard diagnostic method for this difficult-to-diagnose infection.

Background

Mucormycosis is a severe angio-invasive fungal disease with high mortality rates. Conventional diagnostic methods including culture and histopathology are insensitive and time-consuming. Recent advances in PCR-based diagnosis show promise, but systematic evaluation of performance across specimen types is lacking.

Objective

To examine the comparative diagnostic performance of polymerase chain reaction (PCR) assays for diagnosing mucormycosis across different specimen types and patient populations using a systematic review and meta-analysis approach against EORTC-MSGERC 2020 definitions.

Results

Overall pooled sensitivity was 90.3% and specificity 95.0%. BALF provided highest sensitivity (97.5%) and specificity (95.8%), followed by tissue (86.4% sensitivity, 90.6% specificity), blood (81.6% sensitivity, 95.5% specificity), and FFPE specimens (73.0% sensitivity, 96.4% specificity). Specimen type, study design, and disease prevalence explained heterogeneity better than PCR type or patient population.

Conclusion

PCR demonstrates high diagnostic performance for mucormycosis with BALF as the preferred specimen for pulmonary disease and blood PCR as a non-invasive screening tool for high-risk patients. Results support incorporation of PCR detection into updated diagnostic guidelines for mucormycosis.
  • Published in:eClinicalMedicine,
  • Study Type:Meta-analysis,
  • Source: PMID: 40083443
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