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Published on: July 9, 2014
Biopsy procedures for molecular tissue diagnosis of invasive fungal infections
Cornelia Mrazek1, Cornelia Lass-Flörl
1Division of Hygiene and Medical Microbiology, Medical University Innsbruck, Fritz Pregl Straße 3/III, 6020, Innsbruck, Austria.
Abstract:
The incidence of invasive fungal infections (IFI) has increased substantially and the epidemiology has changed dramatically in recent years. Candida albicans is still most important, but non-albicans species, Aspergillus species, Glomeromycota (formerly Zygomycetes) and Fusarium species are an increasing cause of IFIs. Due to this growing diversity, the identification of the causative organism to genus and species level is important to perform best and adequate treatment. The early, sensitive and specific detection of IFIs remains challenging and current conventional methods are limited. The golden standard for the definite diagnosis of proven pulmonary infection remains either histopathologic, cytopathologic or direct tissue examination. Invasive procedures are necessary to obtain reliable specimens and biopsies may be taken percutaneously, bronchoscopically, via open surgery or via video-assisted thorascopic surgery. Molecular methods, like PCR or in situ hybridization, are a promising diagnostic tool for rapid and reliable species identification and should be performed in addition to microscopic examination and culture to increase the sensitivity for the diagnosis of IFI. Combining culture, microscopy, serology, and PCR in lung tissues and/or bronchial samples will increase the diagnostic yield by 99%. Here, we give an overview of biopsy procedures for molecular tissue diagnosis of IFI.
Insights
Invasive fungal infections are rising, with diverse species causing illness. Molecular methods combined with traditional techniques significantly improve early and accurate diagnosis from tissue samples.
Area of Science:
- Mycology
- Infectious Diseases
- Diagnostic Pathology
Background:
- Invasive fungal infections (IFIs) incidence and epidemiology are changing, with increasing roles of non-albicans Candida, Aspergillus, Glomeromycota, and Fusarium species.
- Accurate identification of fungal pathogens is crucial for effective treatment due to this growing diversity.
- Early, sensitive, and specific detection of IFIs remains a significant diagnostic challenge with limitations in conventional methods.
Purpose of the Study:
- To provide an overview of biopsy procedures for molecular tissue diagnosis of IFIs.
- To highlight the importance of accurate fungal identification for optimal patient management.
- To discuss the role of advanced diagnostic tools in combating IFIs.
Main Methods:
- Review of biopsy procedures for obtaining specimens for fungal infection diagnosis.
- Integration of molecular methods (PCR, in situ hybridization) with traditional methods (microscopy, culture, serology).
- Examination of lung tissues and bronchial samples for pathogen detection.
Main Results:
- The golden standard for diagnosing proven pulmonary IFIs involves histopathologic, cytopathologic, or direct tissue examination.
- Invasive procedures like percutaneous, bronchoscopic, or surgical biopsies are necessary for reliable specimen collection.
- Combining culture, microscopy, serology, and PCR in tissue and bronchial samples can increase diagnostic yield up to 99%.
Conclusions:
- Molecular methods offer a promising avenue for rapid and reliable fungal species identification in IFIs.
- A multimodal diagnostic approach, including molecular techniques alongside conventional methods, is essential for maximizing diagnostic yield.
- Optimizing biopsy procedures for molecular tissue diagnosis is key to improving the management of invasive fungal infections.
