The Diagnosis of Fungal Neglected Tropical Diseases (Fungal NTDs) and the Role of Investigation and Laboratory Tests: An Expert Consensus Report
The Diagnosis of Fungal Neglected Tropical Diseases (Fungal NTDs) and the Role of Investigation and Laboratory Tests: An Expert Consensus Report
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DOI：
10.3390/tropicalmed4040122
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发表时间：
2019-12-01
影响因子：
2.9
通讯作者：
Zijlstra, Eduard E.
中科院分区：
文献类型：
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作者：
Hay, Roderick;Denning, David W.;Zijlstra, Eduard E.
被忽视的真菌病 (NTD) 的诊断主要基于对疑似病例的初步视觉识别，然后进行确认性实验室检测，而实验室检测通常仅限于专门设施。尽管分子和血清诊断工具已经取得了进步，但在流行病环境中，理想与实际之间仍然存在很大差距。为了进一步探讨这个问题，我们对主题专家进行了一项调查，调查了针对足菌肿、着色芽生菌病和孢子丝菌病这三种真菌 NTD 的最佳诊断方法，这些方法足以在设备齐全的基础医疗保健环境中启动治疗，以及最佳采样方法。对 23 个中心的调查发现，半侵入性取样方法（例如活检诊断）与拭子或印模涂片相比的关键作用，以及组织病理学、直接显微镜检查和在设备齐全的实验室中进行足菌肿和着色芽生菌病确认的培养的重要性达成了共识。据报道，在基本医疗保健环境中，直接显微镜检查结合临床体征是提示转诊治疗的最有用的诊断指标。该调查发现，孢子丝菌病的诊断是最成问题的，除了真菌培养之外，最广泛使用的实验室测试的敏感性较差，这凸显了提高真菌学诊断能力和开发创新诊断解决方案的必要性。真菌显微镜检查和培养现已被认为是世卫组织必不可少的诊断测试，更好的应用培训将有助于改善这种情况。特别是对于足菌肿和孢子丝菌病，识别特定标记抗原或基因组序列的进展可能为新的基于实验室或即时护理的测试铺平道路，尽管考虑到可引起真菌 NTD 的不同生物体数量众多，这是一项艰巨的任务。
The diagnosis of fungal Neglected Tropical Diseases (NTD) is primarily based on initial visual recognition of a suspected case followed by confirmatory laboratory testing, which is often limited to specialized facilities. Although molecular and serodiagnostic tools have advanced, a substantial gap remains between the desirable and the practical in endemic settings. To explore this issue further, we conducted a survey of subject matter experts on the optimal diagnostic methods sufficient to initiate treatment in well-equipped versus basic healthcare settings, as well as optimal sampling methods, for three fungal NTDs: mycetoma, chromoblastomycosis, and sporotrichosis. A survey of 23 centres found consensus on the key role of semi-invasive sampling methods such as biopsy diagnosis as compared with swabs or impression smears, and on the importance of histopathology, direct microscopy, and culture for mycetoma and chromoblastomycosis confirmation in well-equipped laboratories. In basic healthcare settings, direct microscopy combined with clinical signs were reported to be the most useful diagnostic indicators to prompt referral for treatment. The survey identified that the diagnosis of sporotrichosis is the most problematic with poor sensitivity across the most widely available laboratory tests except fungal culture, highlighting the need to improve mycological diagnostic capacity and to develop innovative diagnostic solutions. Fungal microscopy and culture are now recognized as WHO essential diagnostic tests and better training in their application will help improve the situation. For mycetoma and sporotrichosis, in particular, advances in identifying specific marker antigens or genomic sequences may pave the way for new laboratory-based or point-of-care tests, although this is a formidable task given the large number of different organisms that can cause fungal NTDs.