Abstract
Early detection is critical to the successful treatment of life-threatening infections caused by fungal pathogens, as late diagnosis of systemic infection almost always equates with a poor prognosis. The field of fungal diagnostics has some tests that are relatively simple, rapid to perform and are potentially suitable at the point of care. However, there are also more complex high-technology methodologies that offer new opportunities regarding the scale and precision of fungal diagnosis, but may be more limited in their portability and affordability. Future developments in this field are increasingly incorporating new technologies provided by the use of new format biosensors. This overview provides a critical review of current fungal diagnostics and the development of new biophysical technologies that are being applied for selective new sensitive fungal biosensors to augment traditional diagnostic methodologies.
Highlights
Fungal infections represent a very high burden to world health and necessitate a considerable resource requirement for medical intervention
Serum GM can be useful in predicting the outcome and assessing the response to antifungal therapy, but providing a higher cut-off index value is used it has been demonstrated that the galactomannan test conducted on bronchoalveolar lavage fluid (BAL) fluid is more sensitive and specific as an early diagnostic test for pulmonary aspergillosis [63]
We describe examples of how these methodologies are currently utilised, and what future opportunities exist for the design of next-generation fungal diagnostic strategies
Summary
Fungal infections represent a very high burden to world health and necessitate a considerable resource requirement for medical intervention. Late diagnosis of systemic fungal disease is associated with a poor prognosis [5,6] For this reason, the development of accurate, rapid, specific and sensitive diagnostic tests has become a medical imperative. A strong reliance is still made on microscopy and fungal culture in vitro, histopathology, radiographic and CT imaging, serology and antigen detection tests including the use of lateral flow devices [8] Some of these diagnostic methods have the advantage that they can be developed into point-of-care tests that can be applied under circumstances where advanced bespoke mycological expertise, such as that available in national mycological reference centres, is not available. This review surveys the range of options that are currently available and under development, making specific reference to new and evolving techniques that have the potential to create diagnostics that are highly sensitive and specific and can be undertaken rapidly without any requirement for isolation and culture of the unknown aetiological agent of infection
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