Abstract
What was once just culture and microscopy the field of diagnostic mycology has significantly advanced in recent years and continues to incorporate novel assays and strategies to meet the changes in clinical demand. The emergence of widespread resistance to antifungal therapy has led to the development of a range of molecular tests that target mutations associated with phenotypic resistance, to complement classical susceptibility testing and initial applications of next-generation sequencing are being described. Lateral flow assays provide rapid results, with simplicity allowing the test to be performed outside specialist centres, potentially as point-of-care tests. Mycology has responded positively to an ever-diversifying patient population by rapidly identifying risk and developing diagnostic strategies to improve patient management. Nowadays, the diagnostic repertoire of the mycology laboratory employs classical, molecular and serological tests and should be keen to embrace diagnostic advancements that can improve diagnosis in this notoriously difficult field.
Highlights
The impact of fungal disease is greatly overlooked, but with an ever-increasing immunosuppressed or immune-modulated at-risk population, coupled with inevitable exposure to fungi and the availability of more sensitive diagnostics, cases of fungal disease will inevitably increase [1]
Fluorescent probes specific to the prolyl endopeptidase substrate motif were employed and were capable of detecting infection in animals that was comparable to existing diagnostic tests, but varied between A. fumigatus strains [66]
The methodological standardization, availability of commercial Fungal PCR assays and external quality control schemes have permitted the inclusion of molecular tests into the second revision of the EORTC/MSGGERC definitions for classifying invasive fungal disease (IFD) and will likely enhance the use of fungal PCR testing making it comparable with antigen testing
Summary
The impact of fungal disease is greatly overlooked, but with an ever-increasing immunosuppressed or immune-modulated (monoclonal antibody therapies) at-risk population, coupled with inevitable exposure to fungi and the availability of more sensitive diagnostics, cases of fungal disease will inevitably increase [1]. While the world struggles to cope with the COVID-19 pandemic, not unexpectedly, fungi have exploited the situation, causing severe, secondary invasive fungal disease (IFD) in critically ill COVID-19 patients, highlighting the difficulty of diagnosing IFD in the heterogeneous intensive care unit (ICU) population [2,3,4]. The incidence of IFD in the ICU may be significantly overlooked and while Candida is generally accepted as the most likely cause of critical-care IFD, the significance of IA (incidence: 12.4%) was recently highlighted in a multicentre, UK-based study of 194 mechanically ventilated ICU patients, lengthening ICU stay by a median of 10 days and potentially increasing mortality [5]. This review will summarize recent diagnostic developments and application of novel methods in diagnostic mycology
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