Molecular Methods for the Diagnosis of Invasive Candidiasis.

Iris Camp,Kathrin Spettel,Birgit Willinger

doi:10.3390/jof6030101

Abstract

Invasive infections caused by members of the genus Candida are on the rise. Especially patients in intensive care units, immunocompromised patients, and those recovering from abdominal surgery are at risk for the development of candidemia or deep-seated candidiasis. Rapid initiation of appropriate antifungal therapy can increase survival rates significantly. In the past, most of these infections were caused by C. albicans, a species that typically is very susceptible to antifungals. However, in recent years a shift towards infections caused by non-albicans species displaying various susceptibly patterns has been observed and the prompt diagnosis of the underlying species has become an essential factor determining the therapeutic outcome. The gold standard for diagnosing invasive candidiasis is blood culture, even though its sensitivity is low and the time required for species identification usually exceeds 48 h. To overcome these issues, blood culture can be combined with other methods, and a large number of tests have been developed for this purpose. The aim of this review was to give an overview on strengths and limitations of currently available molecular methods for the diagnosis of invasive candidiasis.

Highlights

The genus Candida comprises a diverse group of dimorphic fungi that are commensal inhabitants of mucous membranes [1] some species, like C. parapsilosis, can be found as colonizers on the human skin [2]
Candida species are often isolated from non-sterile clinical samples, such as swabs from the gastrointestinal or urogenital tract. Even though these findings usually do not hold any pathologic value in asymptomatic immunocompetent patients, Candida can cause invasive infections that are marked by high mortality rates [3,4]
A positive T2Candida result within the first 5 days after the report of a positive BC was an independent risk factor for complicated candidemia, defined by attributable mortality or development of metastatic, deep-seated infection [67]. In another multi-center investigation, Munoz et al showed that T2Candida performed in patients with proven candidemia may be a better marker of complicated infection than follow-up blood cultures or detection of beta-D-glucan (BDG)

Summary

Introduction

The genus Candida comprises a diverse group of dimorphic fungi that are commensal inhabitants of mucous membranes [1] some species, like C. parapsilosis, can be found as colonizers on the human skin [2]. Candida species are often isolated from non-sterile clinical samples, such as swabs from the gastrointestinal or urogenital tract Even though these findings usually do not hold any pathologic value in asymptomatic immunocompetent patients, Candida can cause invasive infections that are marked by high mortality rates [3,4]. The observed shift towards non-albicans species makes it more difficult to choose the appropriate empiric therapy Another concern is the emergence of C. auris. The spectrum of clinical signs and symptoms of IC is wide and can be unspecific, but an invasive fungal disease should always be considered if the patient’s condition does not improve under antibiotic therapy, especially if colonization with Candida spp. has been observed in a high-risk patient. We will focus on commercially available tests (Figure 1)

Overview availablemolecular molecular tests tests for of of invasive

Method

Blood Culture Independent Molecular Diagnostics

Findings

Summary