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PCR-Diagnostik von Mukormykosen aus Gewebeschnitten

PCR-based diagnosis of mucormycosis in tissue samples

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Zusammenfassung

Mukormykosen sind durch einen raschen, häufig letalen Verlauf charakterisiert. Im Gegensatz zu den häufigeren und differenzialdiagnostisch zu erwägenden Aspergillosen ist die Therapie im Wesentlichen auf Amphotericin B limitiert. Nur durch eine schnelle korrekte Zuordnung der histologisch nachweisbaren Hyphen und eine frühzeitige adäquate antimykotische Therapie kann die Letalität dieser invasiven Mykose signifikant gesenkt werden. Die histologische Diagnose ist abhängig von Anzahl und Form der Pilzelemente und der Erfahrung des Untersuchers. In Studien beträgt die Präzision der Histologie etwa 80 %. Polymerasekettenreaktion(PCR)-Verfahren mit Zielsequenz in ribosomalen Genen der ursächlichen Mucorales ermöglichen eine schnelle und spezifische Identifikation sowie den Nachweis möglicher Doppelinfektionen. Zur Therapiesteuerung sollten PCRs als ergänzende Diagnostik unbedingt eingesetzt werden. In der retrospektiven Analyse ermöglichen sie, Therapieoptionen hinsichtlich ursächlicher Gattungen und Mehrfachinfektionen zu evaluieren und somit zukünftige Therapiemodalitäten zu optimieren.

Abstract

Mucormycosis is characterized by a rapid, often fatal progression. Early diagnosis of invasive mucormycosis is the key for timely therapeutic intervention and improved survival. Contrary to the more prevalent aspergillosis, effective antifungal therapy of mucormycosis is mainly limited to amphotericin B. Given the importance to guide the timely initiation of amphotericin B and possible surgical intervention, rapid and specific identification of fungal hyphae is essential. Conventional histopathology depends on abundance and morphology of the fungi as well as on the skills of the personnel, and usually shows an accuracy of 80 %. PCR assays targeting fungal ribosomal genes to identify Mucorales at least at genus level increase sensitivity, allow a rapid identification as well as detection of double mold infections. Thus, PCR assays are beneficial to complement existing approaches. They are recommended to rapidly specify tissue diagnosis and accurate identification of fungi. This will help to guide effective therapy and thereby, survival will increase. Retrospective analyses of mucormycosis by PCR help to evaluate therapeutic interventions and will optimize treatment options.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. R. Bialek und U.E. Zelck geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. LADR GmbH MVZ Dr. Kramer & Kollegen, Geesthacht, Lauenburger Str. 67, 21502, Geesthacht, Deutschland

    R. Bialek & U.E. Zelck

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Correspondence to R. Bialek.

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Bialek, R., Zelck, U. PCR-Diagnostik von Mukormykosen aus Gewebeschnitten. Pathologe 34, 511–518 (2013). https://doi.org/10.1007/s00292-013-1831-9

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