An Approach to Fungal Diagnostics in Solid Organ Transplantation

Abstract

The approach to diagnosing fungal infections following solid organ transplantation (SOT) is patient-specific. An assessment of an individual's risk for particular infections, also understood as the pre-test probability, should guide appropriate diagnostic testing whereas diagnostic stewardship is needed to produce interpretable, actionable and cost-sensitive results. This review provides a cognitive framework for practitioners aiming to diagnose fungal infections in recipients of SOT, taking into consideration the benefits and limitations of currently available diagnostic platforms. In order to better characterize diagnostic utility for this population, we focus on clinical studies that include patients with SOT in full or in part. The goal of this review is to improve the diagnosis of fungal infections in patients with SOT by encouraging a thoughtful, systematic diagnostic approach.

Antifungal stewardship in solid‐organ transplantation: What is needed?

“…There is no 100% sensitive and specific diagnostic test, and the prevalence of infection in the population investigated has an impact on positive and negative predictive values. 30 To detect IFI early, a high index of suspicion must be maintained while balancing diagnostic and antifungal management. The use of fungal biomarkers can improve diagnostic accuracy, which leads to better clinical results.…”

“…It, on the other hand, has good sensitivity and specificity, and is far superior to blood culture for detecting deep‐seated candidiasis. Matrix‐assisted laser desorption ionization–time of flight mass spectrometry has demonstrated good accuracy in the identification of yeast and is currently being utilized in clinical laboratories for routine yeast diagnosis 30 . Finally, there is growing evidence to support the use of blood candida polymerase chain reaction (PCR), which has great specificity and sensitivity, although no international consensus technique exists as of yet.…”

“…The absence of effective diagnostic tools, as well as the range of clinical signs, make diagnosis difficult. There is no 100% sensitive and specific diagnostic test, and the prevalence of infection in the population investigated has an impact on positive and negative predictive values 30 . To detect IFI early, a high index of suspicion must be maintained while balancing diagnostic and antifungal management.…”