ECIL-3 classical diagnostic procedures for the diagnosis of invasive fungal diseases in patients with leukaemia

Abstract

Invasive fungal diseases (IFDs) continue to cause considerable morbidity and mortality in patients with haematological malignancy. Diagnosis of IFD is difficult, with the sensitivity of the gold standard tests (culture and histopathology) often reported to be low, which may at least in part be due to sub-optimal sampling or subsequent handling in the routine microbiological laboratory. Therefore, a working group of the European Conference in Infections in Leukaemia was convened in 2009 with the task of reviewing the classical diagnostic procedures and providing recommendations for their optimal use. The recommendations were presented and approved at the ECIL-3 conference in September 2009. Although new serological and molecular tests are examined in separate papers, this review focuses on sample types, microscopy and culture procedures, antifungal susceptibility testing and imaging. The performance and limitations of these procedures are discussed and recommendations are provided on when and how to use them and how to interpret the results.

A comprehensive diagnostic approach using galactomannan, targeted β‐d‐glucan, baseline computerized tomography and biopsy yields a significant burden of invasive fungal disease in at risk haematology patients

“…Species identification was only possible in two cases, which may be due to the delay in obtaining a biopsy while patients were on antifungal therapy. However, molecular identification using PCR on biopsy specimens, although not currently an EORTC/MSG criteria, may facilitate species identification and is likely to gain wider acceptance in the future (Paterson et al, 2003;Arendrup et al, 2012).…”

“…The number of bronchoscopies in this study was low and reflects local availability in a timely manner. In some instances either bronchoscopy or biopsy had to be performed and the latter was chosen for its potential value in tissue diagnosis and susceptibility testing (Arendrup et al, 2012) as bronchoscopic examination may not be able to distinguish between colonization and infection (Wald et al, 1997).…”

Critically ill allogeneic hematopoietic stem cell transplantation patients in the intensive care unit: reappraisal of actual prognosis

“…The fungal risk is major during the neutropenic phase, especially in the setting of GvHD requiring corticosteroids. It includes filamentous fungi (Aspergillus species and Mucormycoses) 50,51 and Pneumocystis Jiroveci. Late infections are caused by all types of pathogens, but risks are predictable and surmountable with prevention strategies, such as prophylaxis and post-transplant vaccination.…”

Aspectos actuales de las enfermedades invasivas por hongos filamentosos

“…El conocimiento más amplio de las candidiasis ha permitido también grandes avances diagnósticos y terapéuticos. Entre los avances diagnósticos destacan, desde el punto de vista clínico, las clasificaciones diagnósticas para iniciar un tratamiento empírico, como el Candida score, la mejora sustancial en las técnicas de imagen con el empleo de la tomografía axial computarizada de alta resolución, la resonancia magnética y la tomografía por emisión de positrones, y el empleo de biomarcadores no basados en el cultivo, como 1,3-␤-D-glucano o manano o los anticuerpos antimanano o antimicelio, que permiten anticipar el diagnóstico presuntivo e, incluso, el diagnóstico de certeza en algunos casos 4,5,7,22,24,35 . Estos avances se han acompañado de la disponibilidad de nuevos fármacos de alta eficacia antifúngica, como las candinas (anidulafungina, caspofungina y micafungina) o los triazoles de espectro extendido (voriconazol y posaconazol) 19,31,34 .…”