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The Fungal PCR Initiative's evaluation of in-house and commercial Pneumocystis jirovecii qPCR assays: Toward a standard for a diagnostics assay

Toward a standard for a diagnostics assay
Authors: Maud Gits-Muselli; P Lewis White; Carlo Mengoli; Sharon Chen; Brendan Crowley; Gijs Dingemans; Emilie Fréalle; +18 Authors

The Fungal PCR Initiative's evaluation of in-house and commercial Pneumocystis jirovecii qPCR assays: Toward a standard for a diagnostics assay

Abstract

Abstract Quantitative real-time PCR (qPCR) is increasingly used to detect Pneumocystis jirovecii for the diagnosis of Pneumocystis pneumonia (PCP), but there are differences in the nucleic acids targeted, DNA only versus whole nucleic acid (WNA), and also the target genes for amplification. Through the Fungal PCR Initiative, a working group of the International Society for Human and Animal Mycology, a multicenter and monocenter evaluation of PCP qPCR assays was performed. For the multicenter study, 16 reference laboratories from eight different countries, performing 20 assays analyzed a panel consisting of two negative and three PCP positive samples. Aliquots were prepared by pooling residual material from 20 negative or positive- P. jirovecii bronchoalveolar lavage fluids (BALFs). The positive pool was diluted to obtain three concentrations (pure 1:1; 1:100; and 1:1000 to mimic high, medium, and low fungal loads, respectively). The monocenter study compared five in-house and five commercial qPCR assays testing 19 individual BALFs on the same amplification platform. Across both evaluations and for all fungal loads, targeting WNA and the mitochondrial small sub-unit (mtSSU) provided the earliest Cq values, compared to only targeting DNA and the mitochondrial large subunit, the major surface glycoprotein or the beta-tubulin genes. Thus, reverse transcriptase-qPCR targeting the mtSSU gene could serve as a basis for standardizing the P. jirovecii load, which is essential if qPCR is to be incorporated into clinical care pathways as the reference method, accepting that additional parameters such as amplification platforms still need evaluation.

Keywords

Medical Microbiology - Radboud University Medical Center, MESH: Pneumonia, 570, diagnosis, Medizin, 610, MESH: Molecular Diagnostic Techniques, Pneumocystis carinii, Real-Time Polymerase Chain Reaction, Sensitivity and Specificity, pneumocystosis, Cq, environment/Health, threshold, Humans, DNA, Fungal, Pneumocystis jirovecii, panel specimens, standardization, MESH: Humans, MESH: Bronchoalveolar Lavage Fluid, Pneumocystis, MESH: Real-Time Polymerase Chain Reaction, Pneumonia, Pneumocystis, MESH: DNA, DNA, quantification, quantification cycles, MESH: Pneumocystis carinii, MESH: Sensitivity and Specificity, Radboudumc 17: Women's cancers RIMLS: Radboud Institute for Molecular Life Sciences, PCP, qPCR, whole nucleic acids, Fungal, Molecular Diagnostic Techniques, efficiency, [SDV.EE.SANT]Life Sciences [q-bio]/Ecology, Bronchoalveolar Lavage Fluid

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    selected citations
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    This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
    60
    popularity
    This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
    Top 1%
    influence
    This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
    Top 10%
    impulse
    This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
    Top 10%
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selected citations
These citations are derived from selected sources.
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
60
Top 1%
Top 10%
Top 10%
Green
hybrid