The State-of-the-Art Mycology Laboratory: Visions of the Future
The State-of-the-Art Mycology Laboratory: Visions of the Future
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DOI：
10.1007/s12281-014-0212-z
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发表时间：
2015-03-01
影响因子：
1.4
通讯作者：
Guinea, Jesus
中科院分区：
文献类型：
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作者：
Arendrup, Maiken Cavling;Posteraro, Brunella;Guinea, Jesus
在过去几十年中，侵入性感染已经成为发病率和死亡率的重要原因。有利的结局与早期和适当的抗真菌治疗相关。因此，快速、准确的诊断至关重要。临床真菌学领域在过去的十年中不断发展。念珠菌属和曲霉属的敏感性试验和相关临床折点的参考方法已经开发出来，几种商业敏感性试验已经上市。新的诊断检测方法已经出现，包括用于检测曲霉菌、念珠菌和隐球菌抗原的ELISA和侧流装置; β-D-葡聚糖检测试验;诊断PCR;以及用于鉴定的基质辅助激光解吸电离飞行时间（MALDI-TOF）技术，将来可能还用于敏感性筛查（检测）。最后，分子测序和基因分型方法也有检测。其中一些测试是直接在临床微生物学常规实验室实施，而其他测试则需要真菌学专业知识。在这里，我们提出了一个新的诊断方法的概述，审查选项，以提高灵敏度的经典诊断技术，并评论哪些水平的真菌学专业知识需要不同的诊断测试。这篇综述的目的是总结目前的诊断方法，并讨论如何最好地实施这些方法以获得最先进的真菌学服务的好处和陷阱。
Invasive infections have emerged over the past decades as important causes for morbidity and mortality. Favorable outcome is associated with early and appropriate antifungal treatment. Therefore, rapid and correct diagnosis is of utmost importance. The clinical mycology field has evolved over the past decade. Reference methods for susceptibility testing and associated clinical breakpoints for Candida and Aspergillus have been developed, and several commercial susceptibility tests have been marketed. New diagnostic tests have become available including ELISA and lateral flow devices for the detection of Aspergillus, Candida, and Cryptococcus antigens; beta-D-glucan detection test; diagnostic PCRs; and matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) techniques for identification and perhaps in the future also for susceptibility screening (testing). Finally, molecular sequencing and genotyping methods have tance detection. Some of these tests are straightforward to implement in the routine laboratory for clinical microbiology, whereas others require mycological expertise. Here, we present an overview of the newer diagnostic options, review options for improving sensitivity of classical diagnostic techniques, and also comment on which levels of mycological expertise are required for the different diagnostic tests. The goal of this review is to summarize current diagnostic options and discuss benefits and pitfalls on how these are best implemented in order to obtain state-of-the-art mycology service.