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

Summary

This study reviews how well a molecular test called PCR can diagnose mucormycosis, a dangerous fungal infection. Researchers analyzed 30 studies covering over 5,000 patient samples and found that PCR works very well for detecting this infection, especially when using samples from the lungs. Blood tests were also effective but slightly less sensitive. The study recommends using PCR as part of updated diagnostic guidelines to help doctors catch this serious infection earlier, potentially improving patient outcomes.

Background

Mucormycosis is a severe angio-invasive fungal disease with high mortality rates. Conventional diagnostic methods including culture and histopathology are insensitive, with cultures missing approximately 50% of cases and requiring 3-7 days to grow. Recent advances in PCR-based diagnosis of mucormycosis have shown promise as an alternative diagnostic approach.

Objective

To conduct a systematic review and meta-analysis examining the comparative diagnostic performance of polymerase chain reaction (PCR) assays on different specimen types for diagnosing mucormycosis in patients at risk.

Results

Thirty studies including 5920 PCR reactions on 5147 specimens from 819 proven/probable mucormycosis cases were analyzed. Overall pooled sensitivity was 90.3% and specificity was 95.0%. BALF showed 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).

Conclusion

PCR demonstrates high diagnostic performance for mucormycosis across specimen types, with BALF being the recommended test for pulmonary infection and blood PCR recommended for screening high-risk patients. The findings support incorporation of PCR detection into updated diagnostic guidelines for mucormycosis, with interpretation depending on specimen type, fungal load quantification, and clinical context.
  • Published in:eClinicalMedicine,
  • Study Type:Meta-analysis,
  • Source: PMID: 40083443, DOI: 10.1016/j.eclinm.2025.103115
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