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Silent and prolonged Aspergillus DNAemia in oncohematological patients receiving antifungal prophylaxis: a new phenomenon with clinical implications

Bone Marrow Transplantation volume 46, pages 1016–1017 (2011)Cite this article

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Blennow O et al. have recently reported that detection of fungal DNA in a single sample of peripheral blood is a poor indicator of early invasive fungal infection in patients undergoing reduced-intensity conditioning hematopoietic SCT.1 However, our experience with the use of real time-PCR (RT-PCR) assay is completely different. We have previously described a RT-PCR assay which has a high sensitivity and specificity for the diagnosis of invasive aspergillosis (IA) in oncohematological patients when at least two blood samples are positive.2 The low yield of the PCR technique in the study by Blennow et al. could be because these authors used one PCR positive sample as the diagnostic criterion. Although, theoretically, the use of antifungal prophylaxis during the first 100 days after hematopoietic SCT may have contributed to reducing the sensitivity of DNA detection by PCR, as occurs with the detection of galactomannan (GM) Ag,3 our data suggest that detection of DNAemia of Aspergillus sp. by RT-PCR in two or more samples is a very early marker of silent infection in patients receiving antifungal prophylaxis.

These data indicate that DNAemia, contrary to what is suggested by Blennow et al., could be a very early marker of silent infection by Aspergillus sp. in patients receiving antifungal prophylaxis, improving the ability of GM to detect occult infection in this situation. This observation could change our current concept of the natural history of IA. GM seems to be released when Aspergillus is found in exponential growth phase, while fungal DNA is released when the hyphae break up.4 Prophylaxis treatment could limit the exponential growth of the fungus, decreasing the amount of GM in blood until the infection had spread sufficiently to render the prophylactic treatment ineffective. Detection of persistent DNAemia of Aspergillus sp. based on RT-PCR may be the reference technique in a diagnostic-driven strategy to manage IA pre-emptively, improving the outcome of neutropenic patients with occult IA.

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References

  1. Blennow O, Remberger M, Klingspor L, Omazic B, Fransson K, Ljungman P et al. Randomized PCR-based therapy and risk factors for invasive fungal infection following reduced-intensity conditioning and hematopoietic SCT. Bone Marrow Transplant 2010; 45: 1710–1718.

    Article  CAS  Google Scholar 

  2. Cuenca-Estrella M, Meije Y, Diaz-Pedroche C, Gomez-Lopez A, Buitrago MJ, Bernal-Martinez L et al. Value of serial quantification of fungal DNA by a real-time PCR-based technique for early diagnosis of invasive Aspergillosis in patients with febrile neutropenia. J Clin Microbiol 2009; 47: 379–384.

    Article  CAS  Google Scholar 

  3. Marr KA, Laverdiere M, Gugel A, Leisenring W . Antifungal therapy decreases sensitivity of the Aspergillus galactomannan enzyme immunoassay. Clin Infect Dis 2005; 40: 1762–1769.

    Article  CAS  Google Scholar 

  4. Mennink-Kersten MA, Ruegebrink D, Wasei N, Melchers WJ, Verweij PE . In vitro release by Aspergillus fumigatus of galactofuranose antigens, 1,3-beta-D-glucan, and DNA, surrogate markers used for diagnosis of invasive aspergillosis. J Clin Microbiol 2006; 44: 1711–1718.

    Article  CAS  Google Scholar 

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Acknowledgements

This work was supported by research projects from the Fundación Ramon Areces (MPY 1397/04), the Instituto de Salud Carlos III (MPY 1279/05), and from Ministerio de Sanidad y Consumo, Instituto de Salud Carlos III—FEDER, Spanish Network of Infection in Transplantation (RESITRA G03/075) and Spanish Network for the Research in Infectious Diseases (REIPI RD06/0008).

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Authors and Affiliations

  1. Unit of Infectious Diseases, University Hospital 12 de Octubre, Madrid, Spain

    Y Meije & J M Aguado

  2. Servicio de Micología, Centro Nacional de Microbiologia, Instituto de Salud Carlos III, Madrid, Spain

    M Cuenca-Estrella

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  1. Y Meije
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  2. J M Aguado
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  3. M Cuenca-Estrella
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Correspondence to Y Meije.

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Meije, Y., Aguado, J. & Cuenca-Estrella, M. Silent and prolonged Aspergillus DNAemia in oncohematological patients receiving antifungal prophylaxis: a new phenomenon with clinical implications. Bone Marrow Transplant 46, 1016–1017 (2011). https://doi.org/10.1038/bmt.2010.219

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