泛细菌和泛真菌 PCR 在眼底病中的应用:病例报告和文献综述。

IF 2.9 Q1 OPHTHALMOLOGY
Carson W Ercanbrack, Dania A Rahal, Muhammad Z Chauhan, Sayena Jabbehdari, Sami H Uwaydat
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引用次数: 0

摘要

背景:眼内炎是一种临床诊断,但确定致病因子后,就能采取更有针对性的治疗。这通常是通过眼内液培养和染色完成的。然而,培养阴性的眼内炎比较常见,而且无法确定致病菌。因此,可能需要进行进一步的诊断检测,如泛细菌和泛真菌聚合酶链反应(PCR)。身体:现在有了更新的其他检测方法,特别是泛细菌和泛真菌 PCR,当定量 PCR 和培养结果仍为阴性时,眼科医生可以通过这些方法分离出致病菌。我们在一份病例报告中介绍了泛真菌 PCR 是定量 PCR、培养和活检中唯一能够确定眼底病病原体的检测方法。与定量 PCR 相比,pan-PCR 具有独特的优势,因为它不会因污染而导致假阳性结果。相反,pan-PCR 也有缺点,包括无法检测病毒和寄生虫,以及周转时间和成本增加。根据两项大型回顾性研究,pan-PCR 被确定不推荐用于常规的全身感染病例,因为它通常不会增加诊断工作的价值,也不会改变大多数病例的治疗方案。不过,在类似本病例的情况下,如果经验性治疗失败或无法分离出感染性病原体,可以考虑使用泛细菌和泛真菌 PCR。如果泛细菌和真菌 PCR 检测结果仍为阴性或眼内炎持续存在,那么下一代测序这种更新的检测方法可能有助于对培养阴性的眼内炎进行诊断:结论:泛细菌和泛真菌 PCR 检测是一种相对较新的诊断工具,与传统的培养和 PCR 方法相比具有独特的优点和缺点。与这些检测方法在非眼科系统性感染中的应用类似,泛细菌和泛真菌 PCR 不太可能成为初步诊断检测方法并完全取代培养方法。不过,如果用传统方法无法确定感染病原体,或眼底病的经验性治疗仍然失败,它们可以提供有用的诊断信息。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Utility of pan-bacterial and pan-fungal PCR in endophthalmitis: case report and review of the literature.

Background: Endophthalmitis is a clinical diagnosis but identification of the disease-causing agent or agents allows for a more tailored treatment. This is routinely done through intraocular fluid cultures and staining. However, culture-negative endophthalmitis is a relatively common occurrence, and a causative organism cannot be identified. Thus, further diagnostic testing, such as pan-bacterial and pan-fungal polymerase chain reactions (PCRs), may be required. BODY: There are now newer, other testing modalities, specifically pan-bacterial and pan-fungal PCRs, that may allow ophthalmologists to isolate a causative agent when quantitative PCRs and cultures remain negative. We present a case report in which pan-fungal PCR was the only test, amongst quantitative PCRs, cultures, and biopsies, that was able to identify a pathogen in endophthalmitis. Pan-PCR has unique advantages over quantitative PCR in that it does not have a propensity for false-positive results due to contamination. Conversely, pan-PCR has drawbacks, including its inability to detect viruses and parasites and its increased turnaround time and cost. Based on two large retrospective studies, pan-PCR was determined not to be recommended in routine cases of systemic infection as it does not typically add value to the diagnostic workup and does not change the treatment course in most cases. However, in cases like the one presented, pan-bacterial and pan-fungal PCRs may be considered if empiric treatment fails or if the infective organism cannot be isolated. If pan-PCR remains negative or endophthalmitis continues to persist, an even newer form of testing, next-generation sequencing, may aid in the diagnostic workup of culture-negative endophthalmitis.

Conclusion: Pan-bacterial and pan-fungal PCR testing is a relatively new diagnostic tool with unique advantages and drawbacks compared to traditional culturing and PCR methods. Similar to the tests' use in non-ophthalmic systemic infections, pan-bacterial and pan-fungal PCRs are unlikely to become the initial diagnosis test and completely replace culture methods. However, they can provide useful diagnostic information if an infectious agent is unable to be identified with traditional methods or if empiric treatment of endophthalmitis continues to fail.

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来源期刊
CiteScore
3.80
自引率
3.40%
发文量
39
审稿时长
13 weeks
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