title: Combined use of nonculture-based lab techniques in the diagnosis and management of critically ill patients with invasive fungal infections.
abstract: Invasive fungal infections are associated with high morbidity and mortality in critically ill patients due, in part, to diagnostic difficulties in the early stages. Nonculture-based techniques such as (1,3)-β-d-glucan, galactomannan, mannan and antimannan antibodies, Candida albicans germ tube-specific antibodies or fungal DNA are required for earlier diagnosis, prognostic information and monitoring outcome. A decision-tree algorithm based on the combination of nonculture-based techniques is suggested to optimize the diagnosis and evolution of critically ill patients at risk of invasive mycoses. The use of (1,3)-β-d-glucan and blood cultures twice a week is proposed; if positive, treatment initiation is recommended alongside the performance of the nonculture-based microbiological tool depending on suspected mycoses and the availability of techniques.
authors.affiliation: Servicio de Microbiología, Hospital Universitario y Politécnico La Fe, Valencia, Spain. peman_jav@gva.es
authors.forename: Javier
authors.initials: J
authors.lastname: Pemán
authors.forename: Rafael
authors.initials: R
authors.lastname: Zaragoza
mesh_terms: D000908:Antibodies, Fungal / Q000097:blood*; D001230:Aspergillus / Q000302:isolation & purification*; D002175:Candida / Q000302:isolation & purification*; D004271:DNA, Fungal / Q000097:blood*; D003663:Decision Trees; D005690:Galactose / Q000031:analogs & derivatives; D006801:Humans; D008351:Mannans / Q000276:immunology; D009181:Mycoses / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D011509:Proteoglycans; D012698:Serologic Tests; D047071:beta-Glucans / Q000276:immunology
chemical_list: D000908:Antibodies, Fungal; D004271:DNA, Fungal; D008351:Mannans; D011509:Proteoglycans; D047071:beta-Glucans; C012990:galactomannan; C010770:polysaccharide-K; D005690:Galactose