Preemptive antifungal therapy: still a way to go.
OBJECTIVE
Early treatment of invasive mold infections improves the outcome. Therapy is often delayed, however, because available diagnostic tools such as culture, microscopy and conventional radiology lack sensitivity; consequently, empirical initiation of antifungal therapy has been advocated, particularly for patients with prolonged unexplained neutropenic fever.


RESULTS
Much recent progress has been made in the development and evaluation of nonculture-based assays, including the detection of the fungal antigens galactomannan and beta-D-glucan and the detection of fungal DNA by polymerase chain reaction techniques. These new tools should aid the rapid, early diagnosis of invasive fungal disease, especially when used as screening tools in conjunction with sensitive imaging techniques.


CONCLUSIONS
The review will consider these recent developments with the purpose of introducing the concept of preemptive antifungal therapy.
Maertens
Johan
J
Department of Hematology, Acute Leukemia and Stem Cell Transplantation Unit, University Hospital Gasthuisberg, Leuven, Belgium. johan.maertens@uz.kuleuven.ac.be
Deeren
Dries
D
Dierickx
Daan
D
Theunissen
Koen
K
D000935:Antifungal Agents / Q000627:therapeutic use*; D000946:Antigens, Fungal / Q000032:analysis; D004271:DNA, Fungal / Q000032:analysis; D003952:Diagnostic Imaging; D005690:Galactose / Q000031:analogs & derivatives; D006801:Humans; D008351:Mannans / Q000032:analysis; D009181:Mycoses / Q000175:diagnosis* / Q000188:drug therapy* / Q000517:prevention & control; D011509:Proteoglycans; D047071:beta-Glucans / Q000032:analysis
D000935:Antifungal Agents; D000946:Antigens, Fungal; D004271:DNA, Fungal; D008351:Mannans; D011509:Proteoglycans; D047071:beta-Glucans; C012990:galactomannan; C010770:polysaccharide-K; D005690:Galactose