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Diagnosis of invasive respiratory mycoses in the immunocompromised host
Hamish Houston1,2, Andrew J Wilson3, Neil Stone1
1Department of Clinical Microbiology, University College London Hospitals NHS Foundation Trust.
Purpose Of Review:
The burden of invasive fungal infection is increasing worldwide, largely due to a growing population at-risk. Most serious human fungal pathogens enter the host via the respiratory tract. Early identification and treatment of invasive fungal respiratory infections (IFRIs) in the immunocompromised host saves lives. However, their accurate diagnosis is a difficult challenge for clinicians and mortality remains high.
Recent Findings:
This article reviews IFRIs, focussing on host susceptibility factors, clinical presentation, and mycological diagnosis. Several new diagnostic tools are coming of age including molecular diagnostics and point-of-care antigen tests. As diagnosis of IFRI relies heavily on invasive procedures like bronchoalveolar lavage and lung biopsy, several novel noninvasive diagnostic techniques are in development, such as metagenomics, 'volatilomics' and advanced imaging technologies.
Summary:
Where IFRI cannot be proven, clinicians must employ a 'weights-of-evidence' approach to evaluate host factors, clinical and mycological data. Implementation studies are needed to understand how new diagnostic tools can be best applied within clinical pathways. Differentiating invasive infection from colonization and identifying antifungal resistance remain key challenges. As our diagnostic arsenal expands, centralized clinical mycology laboratories and efforts to ensure access to new diagnostics in low-resource settings will become increasingly important.
Insights
Invasive fungal respiratory infections (IFRIs) pose a growing global health threat, especially in immunocompromised individuals. New diagnostic tools are emerging to improve early detection and treatment, though challenges in differentiating infection from colonization persist.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Pulmonology
Background:
- Invasive fungal respiratory infections (IFRIs) present a significant and increasing global health challenge, particularly impacting immunocompromised populations.
- Early diagnosis and treatment of IFRIs are critical for improving patient outcomes, yet accurate diagnosis remains a substantial clinical hurdle, contributing to high mortality rates.
Approach:
- This review synthesizes current knowledge on host susceptibility, clinical manifestations, and mycological diagnostic methods for IFRIs.
- It highlights emerging diagnostic technologies, including molecular diagnostics, point-of-care antigen tests, and novel noninvasive techniques like metagenomics, volatilomics, and advanced imaging.
- The 'weights-of-evidence' approach for unproven IFRI cases and the need for implementation studies are discussed.
Key Points:
- Advancements in diagnostic tools, such as molecular and antigen-based tests, are improving IFRI detection.
- Novel noninvasive diagnostic strategies are under development to overcome limitations of current invasive procedures.
- Key challenges include distinguishing invasive infection from colonization and identifying antifungal resistance.
Conclusions:
- The expanding diagnostic arsenal for IFRIs necessitates optimized clinical pathways and implementation studies.
- Centralized clinical mycology laboratories are crucial for accurate diagnosis and management.
- Ensuring equitable access to new diagnostic technologies in low-resource settings is paramount for global health equity.
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