Fungal Diagnostics

Abstract

Early diagnosis of fungal infection is critical to effective treatment. There are many impediments to diagnosis such as a diminishing number of clinical mycologists, cost, time to result, and requirements for sensitivity and specificity. In addition, fungal diagnostics must meet the contrasting needs presented by the increasing diversity of fungi found in association with the use of immunosuppressive agents in countries with high levels of medical care and the need for diagnostics in resource-limited countries where large numbers of opportunistic infections occur in patients with AIDS. Traditional approaches to diagnosis include direct microscopic examination of clinical samples, histopathology, culture, and serology. Emerging technologies include molecular diagnostics and antigen detection in clinical samples. Innovative new technologies that use molecular and immunoassay platforms have the potential to meet the needs of both resource-rich and resource-limited clinical environments.

Evolution of Cryptococcal Antigen Testing: What Is New?

“…Infection with the human immunodeficiency virus (HIV) and increased use of immunosuppressive therapy have led to an increase in both the frequency and severity of fungal infections [1] • . Cryptococcus neoformans and Cryptococcus gatti are responsible for an estimated 700,000 cases of cryptococcal meningitis in sub Saharan Africa [2] and 7,800 cases of cryptococcal meningitis in North America in 2006 respectively [3].…”

“…Traditional approaches to diagnosis include direct microscopic examination of clinical samples, histopathology, culture, and serology [1] • . However, new innovative technologies that use molecular and immunoassay point-of-care platforms have the potential to meet the needs of both resource-rich and resource-limited clinical environments [4] • .…”

“…Also identified are serotypes B and AD. [1] • Cryptococcus neoformans var. grubii causes most infections among HIV-infected persons [8, 9].…”

Persistent spontaneous fungal peritonitis secondary toCandida albicansin a patient with alcoholic cirrhosis and review of the literature

“…Low BDG levels potentially rule out the disease as it has a high sensitivity 16. Elevated serum BDG levels are indicative of fungaemia in patients with malignancies or those in intensive care units 17.…”

Clinical Utility of a Polymerase Chain Reaction Assay in Culture-Negative Necrotizing Otitis Externa

“…There are growing numbers of fungi that clinical mycologists must identify, and this prompts investigators to apply new methods for fungal identification that go beyond traditional phenotypic methods. As a result, there is an increased emphasis on the use of molecular methods (such as a polymerase chain reaction [PCR] assay) as adjuncts for culture in the diagnosis of fungal diseases (7).…”