Foppiano Palacios Carlo, Spichler Moffarah Anne
Department of Medicine, Division of Infectious Diseases, Yale University School of Medicine, New Haven, CT 06519, USA.
Diagnostics (Basel). 2021 Jul 7;11(7):1226. doi: 10.3390/diagnostics11071226.
Pneumonia is the most common presentation of invasive mold infections (IMIs), and is pathogenetically characterized as angioinvasion by hyphae, resulting in tissue infarction and necrosis. species are the typical etiologic cause of mold pneumonia, with in most cases, followed by the species. Typical populations at risk include hematologic cancer patients on chemotherapy, bone marrow and solid organ transplant patients, and patients on immunosuppressive medications. Invasive lung disease due to molds is challenging to definitively diagnose based on clinical features and imaging findings alone, as these methods are nonspecific. Etiologic laboratory testing is limited to insensitive culture techniques, non-specific and not readily available PCR, and tissue biopsies, which are often difficult to obtain and impact on the clinical fragility of patients. Microbiologic/mycologic analysis has limited sensitivity and may not be sufficiently timely to be actionable. Due to the inadequacy of current diagnostics, clinicians should consider a combination of diagnostic modalities to prevent morbidity in patients with mold pneumonia. Diagnosis of IMIs requires improvement, and the availability of noninvasive methods such as fungal biomarkers, microbial cell-free DNA sequencing, and metabolomics-breath testing could represent a new era of timely diagnosis and early treatment of mold pneumonia.
肺炎是侵袭性霉菌感染（IMIs）最常见的表现形式，其发病机制的特征是菌丝的血管侵袭，导致组织梗死和坏死。曲霉属是霉菌性肺炎的典型病因，在大多数情况下为烟曲霉，其次是黄曲霉。典型的高危人群包括接受化疗的血液系统癌症患者、骨髓和实体器官移植患者以及服用免疫抑制药物的患者。仅根据临床特征和影像学表现来明确诊断霉菌性侵袭性肺病具有挑战性，因为这些方法缺乏特异性。病因学实验室检测仅限于不敏感的培养技术、非特异性且不易获得的PCR以及组织活检，而组织活检往往难以获取且会影响患者的临床脆弱性。微生物学/真菌学分析的敏感性有限，可能不够及时，无法采取有效措施。由于目前诊断方法的不足，临床医生应考虑采用多种诊断方式来预防霉菌性肺炎患者的发病。IMIs的诊断需要改进，真菌生物标志物、微生物游离DNA测序和代谢组学呼气测试等非侵入性方法的应用可能代表着霉菌性肺炎及时诊断和早期治疗的新时代。
