Diagnosis of invasive fungal infections in immunocompromised children

Abstract

Early recognition and rapid initiation of effective treatment is a prerequisite for successful management of children with invasive fungal infections. The increasing diversity of fungal pathogens in high-risk patients, the differences in the antifungal spectra of available agents and the increasing rates of resistance call for identification of the infecting isolate at the species level and for information on drug resistance, in order to provide state-of-the-art patient care. Microscopy and culture of appropriate specimens remain the reference standard for mycological diagnosis, despite difficulties in obtaining appropriate and/or sufficient specimens, long durations of culture and false-negative results. Modern imaging studies and detection of circulating fungal cell wall components and DNA in blood and other body fluids or in affected tissues may improve the laboratory diagnosis of invasive mycoses.

Two Rare Cases Of Central Nervous System Opportunistic Mycoses / Oportunističke Mikoze Središnjega Živčanog Sustava – Prikaz Dvaju Bolesnika

“…Novel systems for detection of circulating fungal cell wall markers and/or DNA in blood and other body fl uids or in affecting tissues may improve the laboratory diagnosis of disseminated aspergillosis (15,23). Our results of in vitro resistance to amphotericin B and susceptibility to voriconazole were comparable with the published data on in vitro activities of these antifungal agents for 13 worldwide clinical A. nidulans isolates from different body sites including brain/CSF (24).…”

“…Conventional techniques including direct microscopy, histopathology and culture of appropriate specimens remain the reference standard for mycological diagnosis of disseminated aspergillosis (15,23 to antifungal agents make identification of the infecting isolate at the species level and determination of its in vitro antifungal susceptibility profiles mandatory (15,23). Novel systems for detection of circulating fungal cell wall markers and/or DNA in blood and other body fl uids or in affecting tissues may improve the laboratory diagnosis of disseminated aspergillosis (15,23).…”

Use of Fungal Diagnostics and Therapy in Pediatric Cancer Patients in Resource-Limited Settings

“…The presence of (1,3)-beta-D-glucan can be detected in Candida , Pneumocystis jirovecii , and certain molds, such as Aspergillus , Fusarium , and Acremonium [81–83]. False-positive results have occurred in the setting of gram-positive bacteremia, hemodialysis, and products containing glucans, which are common events in oncologic patients [84]. Additionally, sample collection, handling, and testing methodology are all critical components, and opportunities for specimen contamination exist during each step of the process.…”

Detection of fungal DNA in lysis–centrifugation blood culture for the diagnosis of invasive candidiasis in neonatal patients

“…In view of these limitations, other techniques for facilitating the diagnosis of IFI have been investigated. Recently, determination of circulating antigens and determination of fungal DNA have been considered to be the most convenient non‐culture methods for the diagnosis of IFIs and monitoring of antifungal treatment [6].…”