Evaluation of Mass Spectrometry-Based Detection of Panfungal Serum Disaccharide for Diagnosis of Invasive Fungal Infections: Results from a Collaborative Study Involving Six European Clinical Centers

• Published in: Journal of clinical microbiology 2019-05, Vol.57 (5)
• Main Authors: Cornu, Marjorie, Sendid, Boualem, Mery, Alexandre, François, Nadine, Mikulska, Malgorzata, Letscher-Bru, Valérie, De Carolis, Elena, Damonti, Lauro, Titecat, Marie, Bochud, Pierre-Yves, Alanio, Alexandre, Sanguinetti, Maurizio, Viscoli, Claudio, Herbrecht, Raoul, Guerardel, Yann, Poulain, Daniel
• Format: Article
• Language: English
• Subjects: Biochemistry, Molecular Biology; Life Sciences; Mycology; Structural Biology
• ISSN: 0095-1137; 1098-660X
• DOI: 10.1128/JCM.01867-18

A mass spectrometry (MS) method that detects a serum disaccharide (DS) (MS-DS) was recently described for the diagnosis of invasive fungal infections (IFI). We carried out a European collaborative study to evaluate this assay. Patients with the following IFI were selected according to the availability of sera obtained at about the time that IFI was documented: invasive candidiasis (IC;  = 26 patients), invasive aspergillosis (IA;  = 19), and mucormycosis (MM;  = 23). Control sera originated from 20 neutropenic patients and 20 patients with bacteremia. MS-DS was carried out in blind manner for the diagnosis of IFI. A diagnosis of IC or IA was confirmed by detection of mannan (Man) or galactomannan (GM), respectively, associated with detection of (1,3)-β-d-glucan (BDG) in both infections. MM was detected by quantitative real-time PCR (qPCR). All tests discriminated sera from patients with IC from sera from control subjects with bacteremia (  ≤ 0.0009). For IC, the MS-DS sensitivity and specificity were 51% and 87%, respectively. MS-DS complemented the high specificity of Man monitoring. All tests discriminated sera from IA patients from sera from neutropenic controls (  ≤ 0.0009). For IA, MS-DS sensitivity and specificity were 64% and 95%, respectively. Only 13/36 serum samples from patients with MM were concordant by MS-DS and qPCR (6 were positive, and 7 were negative); 14 were positive by MS-DS alone. qPCR and MS-DS made a similar contribution to the diagnosis of MM. In patients undergoing long-term monitoring, the persistent circulation of serum disaccharide was observed, whereas DNA was detected only for a short period after initiation of treatment. MS-DS has an important role to play in the early diagnosis of IFI. Its panfungal nature and complementarity with other tests may justify its use in the management of IFI.