Abstract
Non-culture-based diagnostics have been developed to help establish an early diagnosis of invasive fungal infection. Studies have shown that these tests can significantly impact the diagnosis of infection in high risk patients. Aspergillus galactomannan EIA testing is well-recognized as an important adjunct to the diagnosis of invasive aspergillosis and can be detected in serum, bronchoalveolar lavage and other fluids. Galactomannan testing used along with PCR testing has been shown to be effective when integrated into care paths for high risk patients for both diagnoses and as a surrogate marker for outcome when used in serial testing. Beta-d-glucan assays are non-specific for several fungal genera including Aspergillus and Candida and in high risk patients have been an important tool to augment the diagnosis. Lateral flow technology using monoclonal antibodies to Aspergillus are available that allow rapid testing of clinical samples. While standard PCR for Candida remains investigational, T2 magnetic resonance allows for the rapid diagnosis of Candida species from blood cultures. Aspergillus PCR has been extensively validated with standardized approaches established for these methods and will be included in the diagnostic criteria in the revised European Organization for Research and Treatment of Cancer/Mycoses Study Group (EORTC-MSG) definitions. Finally, these non-culture-based tests can be used in combination to significantly increase the detection of invasive mycoses with the ultimate aim of establishing an early diagnosis of infection.
Highlights
Invasive fungal infections remain a significant cause of morbidity and mortality in immunocompromised patients
Non-culture-based diagnostics have been developed to help establish an early diagnosis of infection with the aim of allowing prompt initiation of antifungal therapy and improving patient outcomes
When approaching the use of these assays in the clinical setting, it is important to recognize the risk factors associated with invasive fungal infection, in order to improve the utility of their performance
Summary
Invasive fungal infections remain a significant cause of morbidity and mortality in immunocompromised patients The diagnosis of these infections is delayed due to lack of positive cultures from blood or from tissues, which require invasive procedures to obtain and are often difficult to perform in these critically ill patients. Non-culture-based diagnostics have been developed for both Aspergillus and Candida along with other opportunistic fungal pathogens [1]. These assays have been largely focused on Aspergillus due to its prominence as the most common mold in immunocompromised hosts and for Candida, to augment diagnosis in the setting of negative or delayed positive blood cultures [2]. The data supporting the use of clinically available non-culture-based methods for Aspergillus and Candida will be discussed and their utility alone and in combination will be summarized
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