CITS, Center of Investigation on Health Technology, Polytechnic Health Institute of the North/ESSVA - CESPU, Rua José António Vidal 81, 4760-409 VN Famalicão, Portugal.
Eur J Clin Microbiol Infect Dis. 2013 Jan;32(1):3-9. doi: 10.1007/s10096-012-1722-7. Epub 2012 Aug 18.
The epidemiology of fungal diseases changed, and molds have been increasingly associated with high mortality in severe immunocompromised patients. Invasive mold diseases may originate from the airborne conidia through inhalation or inoculation in skin fissures associated with indwelling catheters, wounds, burns, or onychomycosis. The diagnosis and treatment of fungal diseases is problematic and raises considerable challenges. Diagnosis of invasive mold diseases includes several methodologies, of which the most commonly used are the cultural methods, antigen testing, nucleic acid detection, and radiological imaging. Galactomannan and (1 → 3)-β-D-glucan detection significantly improved mold diagnosis in the last decade. Several molecular strategies have been proposed over the years but no consensus was achieved for standardized protocols or cut-off values. Recently, the first commercially available molecular assay for detection of Aspergillus was tested and the results were highly reproducible. In addition, blood cultures may also be helpful for invasive aspergillosis by following a novel procedure for the recovery of Aspergillus spp. from blood cultures. The association of distinct diagnostic methods, particularly molecular tests, galactomannan, and/or (1 → 3)-β-D-glucan detection, may provide earlier and more sensitive diagnosis of mold diseases and be indicative for early antifungal treatment. Accurate routine use of diagnostic tests can be cost-effective for laboratories and be of great value to patients.
真菌病的流行病学发生了变化，霉菌与严重免疫功能低下患者的高死亡率越来越相关。侵袭性霉菌病可能起源于空气中的分生孢子，通过吸入或接种于与留置导管、伤口、烧伤或甲真菌病相关的皮肤裂隙。真菌病的诊断和治疗存在问题，并带来了相当大的挑战。侵袭性霉菌病的诊断包括几种方法，其中最常用的是培养方法、抗原检测、核酸检测和影像学。过去十年中，半乳甘露聚糖和（1→3）-β-D-葡聚糖检测显著提高了霉菌的诊断。多年来提出了几种分子策略，但尚未就标准化方案或截止值达成共识。最近，测试了第一个可商购的用于检测曲霉菌的分子检测方法，结果具有高度可重复性。此外，血液培养也可能通过一种从血液培养物中回收曲霉菌属的新方法有助于侵袭性曲霉病的诊断。不同诊断方法的联合应用，特别是分子检测、半乳甘露聚糖和/或（1→3）-β-D-葡聚糖检测，可能提供更早、更敏感的霉菌病诊断，并提示早期抗真菌治疗。诊断检测的准确常规使用可以为实验室节省成本，并为患者带来巨大价值。
