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

Summary

Mucormycosis is a dangerous fungal infection that kills many patients. Traditional tests like fungal culture are slow and often miss infections. This comprehensive study of 30 research papers shows that PCR testing is very effective at detecting this fungus, with different specimen types having different success rates. Blood tests were easiest to perform and worked well for screening high-risk patients, while fluid from the lungs was the most accurate.

Background

Mucormycosis is a severe angio-invasive fungal disease with high mortality rates. Conventional diagnostic methods including culture and histopathology have significant limitations, with cultures positive in only 50% of cases and requiring 3-7 days to grow. Recent advances in PCR-based diagnosis show promise for detecting Mucorales in various specimen types.

Objective

To systematically review and meta-analyze the diagnostic performance of PCR assays for diagnosing mucormycosis in patients at risk. The study aimed to compare the performance of PCR on different specimen types and evaluate sensitivity and specificity according to EORTC-MSGERC 2020 definitions.

Results

Overall pooled sensitivity was 90.3% and specificity 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). Specimen type, study design, and disease prevalence were the main sources of heterogeneity.

Conclusion

PCR demonstrates high diagnostic performance for mucormycosis across all specimen types. BALF is recommended for pulmonary mucormycosis diagnosis, while blood PCR serves as a non-invasive screening tool for high-risk patients. The study supports incorporating PCR detection into updated diagnostic guidelines for mucormycosis.
  • Published in:eClinicalMedicine,
  • Study Type:Meta-analysis,
  • Source: PMID: 40083443
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