Diagnosis of invasive fungal diseases in haematology and oncology: 2018 update of the recommendations of the infectious diseases working party of the German society for hematology and medical oncology (AGIHO)

Abstract

Invasive fungal diseases (IFD) are a primary cause of morbidity and mortality in patients with haematological malignancies. These infections are mostly life-threatening and an early diagnosis and initiation of appropriate antifungal therapy are essential for the clinical outcome. Most commonly, Aspergillus and Candida species are involved. However, other Non-Aspergillus moulds are increasingly identified in case of documented IFD. For definite diagnosis of IFD, a combination of diagnostic tools have to be applied, including conventional mycological culture and non-conventional microbiological tests such as antibody/antigen and molecular tests, as well as histopathology and radiology. Although varying widely in cancer patients, the risk of invasive fungal infection is highest in those with allogeneic stem cell transplantation and those with acute leukaemia and markedly lower in patients with solid cancer. Since the last edition of Diagnosis of Invasive Fungal Diseases recommendations of the German Society for Hematology and Oncology in 2012, integrated care pathways have been proposed for the management and therapy of IFDs with either a diagnostic driven strategy as opposed to a clinical or empirical driven strategy. This update discusses the impact of this additional evidence and effective revisions.

Interactions between immune response to fungal infection and microRNAs: The pioneer tuners

“…Considerable outbreak of IFIs is due to the increase of at‐risk individuals, that is in patients infected with human immunodeficiency virus (HIV), patients prolongedly use broad‐spectrum antibiotics, patients undergoing hematopoietic stem cell transplantation (HSCT) and those receiving intensive chemotherapy or radiotherapy. Moreover, lack of controlling strategies for the use of antibiotics, especially in developing countries, is another reason for growing at‐risk hosts . The immune system has pivotal roles in the severity of fungal infections.…”

Aspergillus specific nested PCR from the site of infection is superior to testing concurrent blood samples in immunocompromised patients with suspected invasive aspergillosis

“…Blood samples in various forms (whole blood, plasma or serum) on the other hand are readily available . However, recent, prospective, multicenter data clearly argues for diagnostic algorithms including BAL in haematological patients with lung infiltrates while the rate of complications was very low …”

Prolonged and Resistant Cutaneous Infection in Newly Transplanted Renal Patient

“…Since culture is less sensitive, microscopic demonstration of the characteristic broad hyphae in clinical specimens is the most crucial diagnostic tool and should never be ruled out. Specific fungal stains should be included [4].…”