Guinea Jesús, Bouza Emilio
Servicio de Microbiología Clínica y Enfermedades Infecciosas, Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, C/Dr. Esquerdo, 46, 28007, Madrid, Spain,
Mycopathologia. 2014 Dec;178(5-6):403-16. doi: 10.1007/s11046-014-9763-3. Epub 2014 Jun 20.
The diagnosis of invasive aspergillosis is challenging because no sufficiently sensitive or specific tests have been developed to date. Infection can only be confirmed using histology, although this approach is unavailable in many patients. Therefore, diagnosis of invasive aspergillosis is based on a combination of the presence of host factors, radiological and clinical findings, and mycological criteria. In clinical practice, lack of optimal diagnostics often leads to empirical therapy and great cost and toxicity. Mycological criteria include the isolation of Aspergillus from clinical samples or the detection of biomarkers in fluids. Culture is cheap and easy and enables the identification of fungi and performance of antifungal susceptibility testing; however, it has low sensitivity and specificity. Non-culture-based diagnosis is based on the detection of fungal biomarkers such as galactomannan or (1 → 3)-β-D-glucan in normally sterile body fluids. These procedures enable faster and more sensitive and specific detection of Aspergillus; however, diagnostic accuracy is affected by the patient's underlying condition. Finally, while detection of Aspergillus DNA is promising, the lack of standardization limits its inclusion as a mycological criterion for the definition of probable invasive aspergillosis. New diagnostic procedures based on lateral flow technology are also promising but need further evaluation. In the present review, we discuss current culture-based and non-culture-based procedures for the microbiological diagnosis of invasive aspergillosis.
侵袭性曲霉病的诊断具有挑战性，因为迄今为止尚未开发出足够敏感或特异的检测方法。感染只能通过组织学确诊，不过许多患者无法采用这种方法。因此，侵袭性曲霉病的诊断基于宿主因素、影像学和临床发现以及真菌学标准的综合判断。在临床实践中，缺乏最佳诊断方法常常导致经验性治疗，并带来高昂的成本和毒性。真菌学标准包括从临床样本中分离出曲霉或检测体液中的生物标志物。培养方法廉价且简便，能够鉴定真菌并进行抗真菌药敏试验；然而，其敏感性和特异性较低。非培养诊断基于检测通常无菌的体液中的真菌生物标志物，如半乳甘露聚糖或（1→3）-β-D-葡聚糖。这些方法能够更快、更敏感且特异的检测曲霉；然而，诊断准确性受患者基础疾病的影响。最后，虽然曲霉DNA检测前景广阔，但缺乏标准化限制了其作为可能侵袭性曲霉病定义的真菌学标准的纳入。基于侧向流动技术的新诊断方法也很有前景，但需要进一步评估。在本综述中，我们讨论了目前用于侵袭性曲霉病微生物诊断的基于培养和非培养的方法。
