Early diagnosis of invasive mould infections and disease
Early diagnosis of invasive mould infections and disease
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DOI：
10.1093/jac/dkx030
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发表时间：
2017-03-01
影响因子：
5.2
通讯作者：
Calandra, Thierry
中科院分区：
文献类型：
--
作者：
Lamoth, Frederic;Calandra, Thierry
侵袭性霉菌感染（IMIs），例如侵袭性曲霉病或毛霉菌病，是血液癌症患者和接受长期免疫抑制治疗的患者死亡的主要原因。早期诊断和及时开始抗真菌治疗是 IMI 患者治疗的关键步骤。 IMI 的诊断仍然是一个重大挑战，因为真菌病原体种类不断增加，并且免疫功能低下宿主范围不断扩大，临床和放射学表现也多种多样。诊断很难确定，并以概率（已证实、可能和可能）来表达。影像学（CT 扫描）、微生物学工具（直接检查、培养、PCR、真菌生物标志物）和组织病理学是 IMI 诊断检查的支柱。目前可用的诊断测试均无法单独提供足够的敏感性和特异性，因此最佳方法依赖于多种诊断策略的组合，包括成像、真菌生物标志物（半乳甘露聚糖和 1,3-β-D-葡聚糖）和分子工具。近年来，丝状真菌（主要是曲霉属或毛霉目）PCR的发展以及真菌PCR技术标准化方面取得的进展，可能会导致该领域的未来进步。 IMI 的适当诊断方法应根据每个中心的情况进行个体化，同时考虑 IMI 的当地流行病学和诊断测试的可用性。
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 workup 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-beta-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.