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      A Review of Diagnostic Methods for Invasive Fungal Diseases: Challenges and Perspectives

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          Abstract

          Invasive fungal diseases are associated with a high morbidity and mortality, particularly in the context of immunosuppression. Diagnosis of invasive fungal diseases is usually complicated by factors such as poor clinical suspicion and unspecific clinical findings. Access to modern diagnostic tools is frequently limited in developing countries. Here, we describe five real-life clinical cases from a Brazilian tertiary hospital, in order to illustrate how to best select diagnostic tests in patients with different fungal infections.

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          Time to initiation of fluconazole therapy impacts mortality in patients with candidemia: a multi-institutional study.

          Kevin W. Garey, Milind Rege, Manjunath Pai … (2006)
          Inadequate antimicrobial treatment is an independent determinant of hospital mortality, and fungal bloodstream infections are among the types of infection with the highest rates of inappropriate initial treatment. Because of significant potential for reducing high mortality rates, we sought to assess the impact of delayed treatment across multiple study sites. The goals our analyses were to establish the frequency and duration of delayed antifungal treatment and to evaluate the relationship between treatment delay and mortality. We conducted a retrospective cohort study of patients with candidemia from 4 medical centers who were prescribed fluconazole. Time to initiation of fluconazole therapy was calculated by subtracting the date on which fluconazole therapy was initiated from the culture date of the first blood sample positive for yeast. A total of 230 patients (51% male; mean age +/- standard deviation, 56 +/- 17 years) were identified; 192 of these had not been given prior treatment with fluconazole. Patients most commonly had nonsurgical hospital admission (162 patients [70%]) with a central line catheter (193 [84%]), diabetes (68 [30%]), or cancer (54 [24%]). Candida species causing infection included Candida albicans (129 patients [56%]), Candida glabrata (38 [16%]), Candida parapsilosis (25 [11%]), or Candida tropicalis (15 [7%]). The number of days to the initiation of antifungal treatment was 0 (92 patients [40%]), 1 (38 [17%]), 2 (33 [14%]) or > or = 3 (29 [12%]). Mortality rates were lowest for patients who began therapy on day 0 (14 patients [15%]) followed by patients who began on day 1 (9 [24%]), day 2 (12 [37%]), or day > or = 3 (12 [41%]) (P = .0009 for trend). Multivariate logistic regression was used to calculate independent predictors of mortality, which include increased time until fluconazole initiation (odds ratio, 1.42; P < .05) and Acute Physiology and Chronic Health Evaluation II score (1-point increments; odds ratio, 1.13; P < .05). A delay in the initiation of fluconazole therapy in hospitalized patients with candidemia significantly impacted mortality. New methods to avoid delays in appropriate antifungal therapy, such as rapid diagnostic tests or identification of unique risk factors, are needed.
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            Cryptococcosis in human immunodeficiency virus-negative patients in the era of effective azole therapy.

            G A Pankey, P Pappas, W E Dismukes … (2001)
            We conducted a case study of human immunodeficiency virus (HIV)-negative patients with cryptococcosis at 15 United States medical centers from 1990 through 1996 to understand the demographics, therapeutic approach, and factors associated with poor prognosis in this population. Of 306 patients with cryptococcosis, there were 109 with pulmonary involvement, 157 with central nervous system (CNS) involvement, and 40 with involvement at other sites. Seventy-nine percent had a significant underlying condition. Patients with pulmonary disease were usually treated initially with fluconazole (63%); patients with CNS disease generally received amphotericin B (92%). Fluconazole was administered to approximately two-thirds of patients with CNS disease for consolidation therapy. Therapy was successful for 74% of patients. Significant predictors of mortality in multivariate analysis included age > or =60 years, hematologic malignancy, and organ failure. Overall mortality was 30%, and mortality attributable to cryptococcosis was 12%. Cryptococcosis continues to be an important infection in HIV-negative patients and is associated with substantial overall and cause-specific mortality.
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              T2 magnetic resonance assay for the rapid diagnosis of candidemia in whole blood: a clinical trial.

              Eleftherios Mylonakis, Cornelius Clancy, Luis Ostrosky-Zeichner … (2015)
              Microbiologic cultures, the current gold standard diagnostic method for invasive Candida infections, have low specificity and take up to 2-5 days to grow. We present the results of the first extensive multicenter clinical trial of a new nanodiagnostic approach, T2 magnetic resonance (T2MR), for diagnosis of candidemia.
              Article 0 comments Cited 150 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Alessandro C. Pasqualotto: pasqualotto@santacasa.tche.br
                Journal
                Journal ID (nlm-ta): Infect Dis Ther
                Journal ID (iso-abbrev): Infect Dis Ther
                Title: Infectious Diseases and Therapy
                Publisher: Springer Healthcare (Cheshire )
                ISSN (Print): 2193-8229
                ISSN (Electronic): 2193-6382
                Publication date (Electronic): 29 March 2017
                Publication date PMC-release: 29 March 2017
                Publication date (Print): June 2017
                Volume: 6
                Issue: 2
                Pages: 213-223
                Affiliations
                [1 ]ISNI 0000 0001 0125 3761, GRID grid.414449.8, , Hospital de Clinicas de Porto Alegre, ; Porto Alegre, Brazil
                [2 ]GRID grid.442145.2, , Centro Universitário La Salle Canoas, ; Canoas, Brazil
                [3 ]ISNI 0000 0004 0444 6202, GRID grid.412344.4, , Universidade Federal de Ciências da Saúde de Porto Alegre, ; Porto Alegre, Brazil
                [4 ]Santa Casa de Misericordia de Porto Alegre, Porto Alegre, Brazil
                Article
                Publisher ID: 154
                DOI: 10.1007/s40121-017-0154-1
                PMC ID: 5446367
                PubMed ID: 28357708
                SO-VID: 38f78b95-62b0-48e1-87c2-f8ceacfe61e6
                Copyright © © The Author(s) 2017
                History
                Date received : 3 February 2017
                Categories
                Subject: Review
                Custom metadata
                issue-copyright-statement © Springer Healthcare 2017

                Keywords: antigen detection,beta-d-glucan,galactomannan,maldi-tof,pcr
                Data availability:
                Keywords: antigen detection, beta-d-glucan, galactomannan, maldi-tof, pcr

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