[Clinically documented fungal infections]

Area of Science:

• Medical Mycology
• Infectious Diseases
• Immunocompromised Host Research

Context:

• Invasive fungal infections (IFIs) pose significant threats to immunocompromised patients.
• Accurate and timely diagnosis of IFIs is crucial for effective treatment and improved outcomes.
• Current diagnostic approaches for IFIs involve a combination of clinical, radiological, microbiological, and serological methods.

Purpose:

• To review the diagnostic methods for clinically documented invasive aspergillosis, pulmonary cryptococcosis, and zygomycosis in immunocompromised patients, particularly those with diabetes.
• To highlight the utility and limitations of available diagnostic tools, including serological tests.
• To provide an overview of risk factors, signs, and symptoms associated with these IFIs.

Summary:

• Proven IFIs require histological/microbiological evidence and positive blood cultures (fungemia).
• Clinically documented IFIs are diagnosed using radiological findings (e.g., halo sign on chest CT) and serological/molecular evidence.
• Useful serological markers include Aspergillus galactomannan antigen and beta-glucan for aspergillosis, and cryptococcal glucuronoxylomannan antigen for cryptococcosis. Reliable serological tests for zygomycosis are currently unavailable.

Impact:

• This review aids clinicians in diagnosing and managing IFIs in vulnerable patient populations.
• It emphasizes the need for improved diagnostic strategies, especially for zygomycosis.
• Understanding diagnostic nuances can lead to earlier intervention and better patient prognoses.