Alanio Alexandre, Bretagne Stéphane
Parasitology-Mycology Laboratory, Lariboisière Saint-Louis Fernand Widal hospitals, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France; Paris-Diderot, Sorbonne Paris Cité University, Paris, France; Institut Pasteur, CNRS, Molecular Mycology Unit, Reference National Center of Invasive Mycoses and Antifungals, Paris, France.
F1000Res. 2017 Feb 17;6. doi: 10.12688/f1000research.10216.1. eCollection 2017.
Invasive aspergillosis (IA) has been increasingly reported in populations other than the historical hematology patients and there are new questions about the performance of microbiological tools. Microscopy and culture have been completed by biomarkers, either antigens or DNA, and in blood or respiratory specimens or both. First studied in hematology, the antigen galactomannan performance in serum is low in other patient populations where the pathophysiology of the infection can be different and the prevalence of IA is much lower. DNA detection with polymerase chain reaction (PCR) in blood or serum (or both) has reached a certain level of acceptance thanks to consensus methods based on real-time quantitative PCR (qPCR). When used on respiratory specimens, galactomannan and qPCR depend on standardization of the sampling and the diverse mycological procedures. Thus, culture remains the main diagnostic criterion in critically ill patients. The current trend toward more effective anti-mold prophylaxis in hematology hampers the yield of a screening strategy, as is usually performed in hematology. Therefore, circulating biomarkers as confirmatory tests should be considered and their performance should be reappraised in each new setting. The use of azole prophylaxis also raises the issue of selecting azole-resistance isolates. Ideally, the biomarkers will be more efficient when individual genetic risks of IA are defined. Culture, though not standardized, remains a key element for the diagnosis of IA and has the advantage to easily detect molds other than . It is still unclear whether next-generation sequencing will replace culture in the future.
侵袭性曲霉病（IA）在以往的血液学患者群体之外的人群中报告越来越多，并且微生物学检测工具的性能出现了新的问题。显微镜检查和培养已通过生物标志物（抗原或DNA）在血液或呼吸道标本或两者中完成。血清中的半乳甘露聚糖抗原性能在血液学中首次得到研究，但在其他患者群体中较低，这些群体中感染的病理生理学可能不同且IA的患病率要低得多。由于基于实时定量PCR（qPCR）的共识方法，血液或血清（或两者）中使用聚合酶链反应（PCR）进行DNA检测已达到一定的接受程度。当用于呼吸道标本时，半乳甘露聚糖和qPCR取决于采样的标准化和各种真菌学程序。因此，培养仍然是重症患者的主要诊断标准。血液学中目前更有效的抗霉菌预防趋势阻碍了筛查策略的阳性率，而这在血液学中通常是这样进行的。因此，应考虑将循环生物标志物作为确证试验，并应在每个新环境中重新评估其性能。使用唑类预防也引发了选择唑类耐药菌株的问题。理想情况下，当确定IA的个体遗传风险时，生物标志物将更有效。培养虽然没有标准化，但仍然是IA诊断的关键要素，并且具有易于检测除曲霉之外的霉菌的优势。下一代测序未来是否会取代培养尚不清楚。
