Microbiological and Molecular Diagnosis of Mucormycosis: From Old to New

Abstract

Members of the order Mucorales may cause severe invasive fungal infections (mucormycosis) in immune-compromised and otherwise ill patients. Diagnosis of Mucorales infections and discrimination from other filamentous fungi are crucial for correct management. Here, we present an overview of current state-of-the-art mucormycosis diagnoses, with a focus on recent developments in the molecular field. Classical diagnostic methods comprise histology/microscopy as well as culture and are still the gold standard. Newer molecular methods are evolving quickly and display great potential in early diagnosis, although standardization is still missing. Among them, quantitative PCR assays with or without melt curve analysis are most widely used to detect fungal DNA in clinical samples. Depending on the respective assay, sequencing of the resulting PCR product can be necessary for genus or even species identification. Further, DNA-based methods include microarrays and PCR-ESI-MS. However, general laboratory standards are still in development, meaning that molecular methods are currently limited to add-on analytics to culture and microscopy.

Frequency and causes of antifungal treatment changes in allogeneic haematopoïetic cell transplant recipients with invasive mould infections

“…Moulds, particularly Mucorales and some slowly sporulating Aspergillus spp., may take several days to grow in the microbiology laboratory. [36][37][38][39] Furthermore, PCR is performed at a reference laboratory for our in-…”

“…Hence, treatment initiation could have been delayed until a microbiology result was available. Moulds, particularly Mucorales and some slowly sporulating Aspergillus spp., may take several days to grow in the microbiology laboratory 36–39 . Furthermore, PCR is performed at a reference laboratory for our institution and the turnaround time for test results might have further delayed establishing a diagnosis.…”

Recent Advances and Future Directions in the Understanding of Mucormycosis

“…Appropriate and timely treatment of Mucormycosis to reduce mortality rate requires early detection of the pathogen, which is one of the main targets of current research. Diagnosis is still being performed by classical methods comprising histology/microscopy and culture that show low sensitivity and need a long time, respectively ( Skiada et al., 2018 ; Skiada et al., 2020 ; Lackner et al., 2021 ). Moreover, morphological identification is not reliable and molecular identification is strongly recommended ( Sagatova et al, 2016 ).…”

“…The disease shows high mortality, and its reduction is confronted with several problems. The first one is the scarce tests available for the diagnosis in the early stages of the infection ( Skiada et al., 2018 ; Skiada et al., 2020 ; Lackner et al., 2021 ). Thus, preemptive therapy for patients at a high risk for mucormycosis has been proposed as a strategy to reduce mortality ( Chamilos et al., 2008 ).…”

COVID-19-Associated Mucormycosis, A New Incident in Recent Time: Is An Emerging Disease in The Near Future Impending?

“…The use of conventional cytopathology (CCP) on respiratory samples can aid in detecting Mucorales at a lower cost and in less time. 38 39 …”