Diagnosis of Invasive Fungal Infections - Current Limitations of Classical and New Diagnostic Methods

Diagnosis of Invasive Fungal Infections - Current Limitations of Classical and New Diagnostic Methods

Alessandro C Pasqualotto, David W Denning
European Oncology Review 2005
Published: October 2008
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Despite the availability of new antifungal drugs, the overall survival for immunocompromised patients with invasive fungal infections remains too low, with large variations according to underlying disease.1–15 Although early diagnosis and subsequent early initiation of therapy improves outcome,16–19 diagnosing invasive fungal infections can be difficult. The purpose of this article is to review the available armamentaria for the diagnosis of invasive fungal infections. A brief summary of the main clinical and epidemiological data for these infections is shown in Table 1.3–7,12–15,20–56

Diagnosis of Invasive Fungal Infection

Conventional Methods (Direct Microscopy, Culture and Histopathology)
All fungi obtained from sterile sites should be identified to species level by referral to a specialist laboratory. All bronchoscopy fluids from patients suspected of infection should be examined microscopically for hyphae and cultured on specialised media, and all clinical isolates of Aspergillus should be identified to species level.57

Current ‘conventional methods’ are very limited for the diagnosis of invasive fungal infections. Blood cultures have a low sensitivity for the diagnosis of candidaemia (~50%),58,59 and cultures other than blood are non-specific and can take too long to became positive. Antifungal treatment is recommended following recovery of even one positive blood culture for Candida.5 Identification of Candida spp. by culture requires the presence of viable organisms in blood or body fluids. In addition, several days may be required for blood cultures to become positive and, for non-Albicans spp. of Candida, additional subculturing is required to obtain pure cultures for use in subsequent phenotypic identification systems.59

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