Diagnosis of invasive respiratory mycoses in the immunocompromised host

Abstract

Purpose of reviewThe burden of invasive fungal infection is increasing worldwide, largely due to a growing population at-risk. Most serious human fungal pathogens enter the host via the respiratory tract. Early identification and treatment of invasive fungal respiratory infections (IFRIs) in the immunocompromised host saves lives. However, their accurate diagnosis is a difficult challenge for clinicians and mortality remains high.Recent findingsThis article reviews IFRIs, focussing on host susceptibility factors, clinical presentation, and mycological diagnosis. Several new diagnostic tools are coming of age including molecular diagnostics and point-of-care antigen tests. As diagnosis of IFRI relies heavily on invasive procedures like bronchoalveolar lavage and lung biopsy, several novel noninvasive diagnostic techniques are in development, such as metagenomics, ‘volatilomics’ and advanced imaging technologies.SummaryWhere IFRI cannot be proven, clinicians must employ a ‘weights-of-evidence’ approach to evaluate host factors, clinical and mycological data. Implementation studies are needed to understand how new diagnostic tools can be best applied within clinical pathways. Differentiating invasive infection from colonization and identifying antifungal resistance remain key challenges. As our diagnostic arsenal expands, centralized clinical mycology laboratories and efforts to ensure access to new diagnostics in low-resource settings will become increasingly important.

Patterns and Drivers of Antifungal Prescribing in Acute Leukemia: A Retrospective Cohort Study

“…Compared to diagnostic criteria designed for research studies, clinicians have a lower threshold of suspicion for initiating antifungal therapy [ 1 ]. Invasive investigations (eg, bronchoscopy or biopsy) may be deemed unsafe in sicker patients.…”

“…The population at risk is growing as global access to an ever-increasing range of immunosuppressive therapies improves and the geographic range of fungal pathogens expands, in part due to climate change. However, IFIs remain difficult to diagnose and cause high morbidity and mortality [ 1 ]. Recognizing this growing threat, the World Health Organization published the first priority fungal pathogens list in 2022 [ 2 , 3 ].…”