Akkad Apurva, Nanda Neha
Division of Infectious Disease, Department of Medicine, Keck School of Medicine, University of Southern California, 1500 San Pablo St., Los Angeles, CA 90033, USA.
J Fungi (Basel). 2025 Jan 9;11(1):48. doi: 10.3390/jof11010048.
Fungal infections are common in highly immunosuppressed, solid organ transplant recipients. They can be quite difficult to diagnose in a timely manner; thus, we present a review of current studies focusing on broad categories of molecular diagnostics, i.e., metagenomic sequencing, magnetic resonance, and gas chromatography mass spectrometry. We further discuss their syndrome-specific utilization in the diagnosis of fungemia and disseminated disease, pneumonia, and central nervous system infections. We assess the level of evidence of their utility as fungal diagnostics particularly in solid organ transplant recipients using the STARD criteria. In addition, we provide future research directions to substantiate and appropriately utilize these platforms in clinical practice. Directed polymerase chain reaction testing and targeted metagenomic sequencing are being used clinically and show the most promise, though only in conjunction with conventional methods at this time. The majority of these platforms contain limited data, and thus further larger studies are needed in order to properly implement their use.
真菌感染在接受实体器官移植且免疫功能高度抑制的患者中很常见。它们很难及时诊断；因此，我们对当前聚焦于分子诊断学广泛范畴的研究进行综述，即宏基因组测序、磁共振成像和气相色谱-质谱联用。我们进一步讨论它们在真菌血症和播散性疾病、肺炎及中枢神经系统感染诊断中针对特定综合征的应用。我们依据STARD标准评估它们作为真菌诊断方法的效用证据水平，尤其在实体器官移植受者中的情况。此外，我们提供未来的研究方向，以在临床实践中证实并合理应用这些平台。目前，直接聚合酶链反应检测和靶向宏基因组测序正在临床中使用且显示出最大潜力，不过此时仅能与传统方法联合使用。这些平台大多数据有限，因此需要开展更多更大规模的研究以便正确应用它们。
