Invasive Mycoses: Diagnostic Challenges - 21/12/11

Abstract |
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 β-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.
Le texte complet de cet article est disponible en PDF.Keywords : β-Glucan, d-arabinitol, Galactomannan, Mannan, Non–culture-based diagnostics, PCR assays
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| Statement of author disclosure: Please see the Author Disclosures section at the end of this article. |
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| This supplement is in part based on a closed roundtable meeting that was held June 7, 2011 in New York City and was jointly sponsored by Postgraduate Institute for Medicine and Global Education Exchange through an educational grant from Merck & Co., Inc. The webinar was peer-reviewed and accepted as a free multimedia activity of The American Journal of Medicine and is available at www.antifungaltherapy2.net. |
Vol 125 - N° 1S
P. S14-S24 - janvier 2012 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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