title: Early diagnosis of invasive mould infections and disease.
abstract: Invasive mould infections (IMIs), such as invasive aspergillosis or mucormycosis, are a major cause of death in patients with haematological cancer and in patients receiving long-term immunosuppressive therapy. Early diagnosis and prompt initiation of antifungal therapy are crucial steps in the management of patients with IMI. The diagnosis of IMI remains a major challenge, with an increased spectrum of fungal pathogens and a diversity of clinical and radiological presentations within the expanding spectrum of immunocompromised hosts. Diagnosis is difficult to establish and is expressed on a scale of probability (proven, probable and possible). Imaging (CT scan), microbiological tools (direct examination, culture, PCR, fungal biomarkers) and histopathology are the pillars of the diagnostic work-up of IMI. None of the currently available diagnostic tests provides sufficient sensitivity and specificity alone, so the optimal approach relies on a combination of multiple diagnostic strategies, including imaging, fungal biomarkers (galactomannan and 1,3-β-d-glucan) and molecular tools. In recent years, the development of PCR for filamentous fungi (primarily Aspergillus or Mucorales) and the progress made in the standardization of fungal PCR technology, may lead to future advances in the field. The appropriate diagnostic approach for IMI should be individualized to each centre, taking into account the local epidemiology of IMI and the availability of diagnostic tests.
authors.affiliation: Infectious Diseases Service, Department of Medicine, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland.|Institute of Microbiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Lamoth
authors.affiliation: Infectious Diseases Service, Department of Medicine, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland.
authors.forename: Thierry
authors.initials: T
authors.lastname: Calandra
mesh_terms: D001228:Aspergillosis / Q000175:diagnosis* / Q000000981:diagnostic imaging* / Q000276:immunology; D001232:Aspergillus fumigatus; D042241:Early Diagnosis; D005690:Galactose / Q000031:analogs & derivatives; D019337:Hematologic Neoplasms / Q000188:drug therapy / Q000276:immunology; D006801:Humans; D016867:Immunocompromised Host; D007165:Immunosuppression Therapy; D000072742:Invasive Fungal Infections / Q000175:diagnosis* / Q000276:immunology / Q000382:microbiology; D008279:Magnetic Resonance Imaging / Q000379:methods; D008351:Mannans / Q000097:blood; D009089:Mucor; D009091:Mucormycosis / Q000175:diagnosis* / Q000000981:diagnostic imaging* / Q000276:immunology; D016377:Organ Transplantation / Q000009:adverse effects; D016133:Polymerase Chain Reaction / Q000379:methods; D000072078:Positron Emission Tomography Computed Tomography / Q000379:methods; D014057:Tomography, X-Ray Computed / Q000379:methods; D047071:beta-Glucans / Q000097:blood
chemical_list: D008351:Mannans; D047071:beta-Glucans; C012990:galactomannan; C033363:beta-1,3-glucan; D005690:Galactose