title: Current Algorithms in Fungal Diagnosis in the Immunocompromised Host.
abstract: Invasive fungal diseases (IFDs) are a major cause of morbidity and mortality in immunocompromised patients such as patients with hematological malignancies or allogeneic hematopoietic stem cell transplant recipients. Whereas the definite diagnosis of IFD requires invasive diagnostic procedures, imaging and noninvasive diagnostic assays may help in decision making with regard to the institution and the choice of antifungal agents, the duration of therapy, surgical intervention, and monitoring of fungal manifestations.Unfortunately, signs and symptoms of IFD are often nonspecific in the immunocompromised patient. Therefore, in immunocompromised patients with suspected IFD, all samples collected need to be cultured for fungi, and, in the case of specimens obtained by invasive diagnostic procedures, also microscopically examined. For high sensitivity of the cultural and microscopic approaches, specific media and stains, respectively, are crucial. Non-culture based method such as the detection of galactomannan or ß-d-glucan and molecular tools such as polymerase chain reaction may help in the early diagnosis of IFD. Imaging studies may be indicative for IFD, but invasive diagnostics such as bronchoalveolar lavage and/or biopsy should be pursued in order to identify the causative pathogen. This chapter summarizes the current knowledge on diagnosing IFD and proposes practical help in the use of diagnostic tools.
authors.affiliation: Pediatric Hematology and Oncology, Hospital for Children and Adolescents, Johann Wolfgang Goethe-University, Theodor-Stern-Kai 7, Frankfurt, 60590, Germany. Thomas.Lehrnbecher@kgu.de.
authors.forename: Thomas
authors.initials: T
authors.lastname: Lehrnbecher
authors.affiliation: Institute of Medical Microbiology, University Hospital Münster, Münster, Germany.
authors.forename: Karsten
authors.initials: K
authors.lastname: Becker
authors.affiliation: Department of Pediatric Hematology/Oncology, Infectious Disease Research Program, Center for Bone Marrow Transplantation, University Children's Hospital Münster, Münster, Germany.
authors.forename: Andreas H
authors.initials: AH
authors.lastname: Groll
mesh_terms: D000465:Algorithms; D000908:Antibodies, Fungal / Q000097:blood; D000946:Antigens, Fungal / Q000032:analysis; D018929:Cell Culture Techniques; D062610:Fungal Polysaccharides / Q000032:analysis; D005658:Fungi / Q000235:genetics / Q000378:metabolism / Q000648:ultrastructure; D006801:Humans; D016867:Immunocompromised Host; D008853:Microscopy; D025202:Molecular Diagnostic Techniques; D009181:Mycoses / Q000097:blood / Q000175:diagnosis* / Q000276:immunology / Q000382:microbiology; D016133:Polymerase Chain Reaction
chemical_list: D000908:Antibodies, Fungal; D000946:Antigens, Fungal; D062610:Fungal Polysaccharides
keywords: Biopsy; Brochoalveolar lavage; Computerized tomography; Culture; Galactomannan; Invasive fungal disease; Magnetic resonance imaging; Polymerase chain reaction; ß-d-glucan