Invasive Mycoses: Diagnostic Challenges
Invasive Mycoses: Diagnostic Challenges
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DOI：
10.1016/j.amjmed.2011.10.008
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发表时间：
2012-01-01
影响因子：
5.9
通讯作者：
Ostrosky-Zeichner, Luis
中科院分区：
文献类型：
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作者：
Ostrosky-Zeichner, Luis
尽管有更新的抗真菌药物可用，但侵袭性真菌感染（IFIs）患者的预后仍然不佳，这在很大程度上是由于延迟诊断和开始适当的抗真菌治疗。标准的组织病理学诊断技术在高危患者中通常站不住脚，而基于培养的诊断通常过于不敏感或非特异性，或者在最佳 IFI 管理延迟太长时间后才提供结果。需要具有更高敏感性和特异性的更新的 IFI 替代标记物，以实现早期诊断，并在理想情况下提供预后信息和/或允许治疗监测。替代检测也应该在医院内易于进行和实施。几种基于非培养的新替代物检测方法正在进入医疗领域或目前正在研究中。这些新的或即将出现的替代物包括用于检测侵袭性念珠菌病的抗原/抗体（甘露聚糖和抗甘露聚糖抗体）或真菌代谢物（D-阿拉伯糖醇），用于检测侵袭性曲霉病的曲霉细胞壁成分半乳甘露聚糖，或真菌细胞壁成分和泛真菌标记物β-葡聚糖。此外，使用聚合酶链式反应或其他基于核酸或分子的检测方法诊断特定或通用 IFI 的进展仍在继续，尽管在这些方法中的任何一种可以更全面地应用于医疗环境之前，必须更好地标准化各种方法。研究人员还开始探索将新的替代标记相互结合或与更标准的诊断方法相结合的可能性，以提高敏感性、特异性和早期诊断的能力，此时真菌负荷仍然相对较低且对抗真菌治疗更敏感。 (C) 2012 Elsevier Inc. 保留所有权利。 。美国医学杂志 (2012) 125，S14-S24
Despite the availability of newer antifungal drugs, outcomes for patients with invasive fungal infections (IFIs) continue to be poor, in large part due to delayed diagnosis and initiation of appropriate antifungal therapy. Standard histopathologic diagnostic techniques are often untenable in at-risk patients, and culture-based diagnostics typically are too insensitive or nonspecific, or provide results after too long a delay for optimal IFI management. Newer surrogate markers of IFIs with improved sensitivity and specificity are needed to enable earlier diagnosis and, ideally, to provide prognostic information and/or permit therapeutic monitoring. Surrogate assays should also be accessible and easy to implement in the hospital. Several nonculture-based assays of newer surrogates are making their way into the medical setting or are currently under investigation. These new or up-and-coming surrogates include antigens/antibodies (mannan and antimannan antibodies) or fungal metabolites (D-arabinitol) for detection of invasive candidiasis, the Aspergillus cell wall component galactomannan used to detect invasive aspergillosis, or the fungal cell wall component and panfungal marker beta-glucan. In addition, progress continues with use of polymerase chain reaction-or other nucleic acid-or molecular-based assays for diagnosis of either specific or generic IFIs, although the various methods must be better standardized before any of these approaches can be more fully implemented into the medical setting. Investigators are also beginning to explore the possibility of combining newer surrogate markers with each other or with more standard diagnostic approaches to improve sensitivity, specificity, and capacity for earlier diagnosis, at a time when fungal burden is still relatively low and more responsive to antifungal therapy. (C) 2012 Elsevier Inc. All rights reserved. . The American Journal of Medicine (2012) 125, S14-S24