Contribution of new diagnostic approaches to antifungal treatment plans in high-risk haematology patients

Clinical Microbiology and Infection : the Official Publication of the European Society of Clinical Microbiology and Infectious Diseases
H Einsele, Juergen Loeffler

Abstract

In high-risk patient cohorts, such as patients after solid-organ or allogeneic stem-cell transplantation, or patients with acute leukaemia, early diagnosis of invasive fungal infections (IFIs) is essential, as delayed or missing diagnosis of IFI results in increasing rates of mortality. However, diagnosis of most IFIs, especially of invasive aspergillosis, is difficult because classic tests have low sensitivity and specificity, and radiology often provides non-specific and transient results. The limited sensitivity and specificity of conventional assays for the detection of IFI and the growing number of immunocompromised patients who are at risk for opportunistic fungal infections have led to the development of new assays. These methods include antigen detection systems, such as ELISAs, and different molecular methods (PCR assays). Serological tests, such as the detection of the carbohydrate galactomannan, are standardised and commercially available. However, they still need to be evaluated in large patient cohorts, especially children. The benefit of antibody detection remains unclear if patients are under immune suppression or are heavily colonised but not infected. A range of different PCR assays (conventional, nested, real-...Continue Reading

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