REGISTER
LOG IN
HOME
RESOURCES
Publications
Conference Calendar
Past Quiz Results
ARTICLES
First-ever Study of Mycology Lab Practices in Asia
Fereydounia khargensis: A New Opportunistic Yeast Reported from Malaysia
9 Years of MMTN: Improving Fungal Disease Management in Asia Pacific
Echinocandins: Clinicians' Guide
Fungemia blood culture media
Deep dermatophytosis
AFWG Education Module 4: Is Antifungal Susceptibility Testing Useful for Clinical Management?
AFWG Education Module 5: TDM of Antifungal Agents - Essential or Optional?
AFWG Education Module 6: Antifungal Stewardship
Itraconazole: A Quick Guide for Clinicians
Evolving Fungal Landscape in Asia
Laboratory Diagnosis of Pythiosis
ICMR Issues C. auris Advisory
Strengths and Limitations of Imaging for Diagnosis of IFI
Candidemia: Lessons Learned from Asian Studies for Intervention
Pivotal Asian Invasive Mold Study
Mycetoma in Asia: Still veiled in mystery
Cryptococcosis
New Antifungal Agents
Making Precise Diagnoses: Experience from the Laboratory Skills Enhancement Course
AFWG Online Education Module 3: Optimizing Dosing in IFI Management
AFWG Online Education Module 2: Antifungal Prophylaxis in Solid Organ Transplantation
AFWG Education Module 1: The Value of Clinical Mycology Laboratories
Cryptococcosis in HIV and non-HIV infected patients
Human Pythiosis
AFWGOnline Privacy Policy has been Updated
Recent Advances of Fungal Diagnostics in Asian Laboratories
Deep Dermatophytosis: A Case Report
Emerging yeast infections in Asia
Championing Medical Mycology: Thoughts on the AFWG Laboratory Skills Enhancement Course
Mucormycosis and Pythiosis – New Insights
AML and the high risk of multiple infectious complications
Do We Need Modification of Recent IDSA & ECIL Guidelines while Managing Patients in Asia?
A hospital’s experience with candidemia and empirical therapy
Fungal Academy 2015
Fluconazole in 2015
Fungal isolation protocol
Influencing Aspergillus
Fungal Asthma
Aspergillus
Laboratory Diagnosis of IPA
Two-Hot-to-Handle
Voriconazole
Educational Organizations
Literature Updates
 

Articles

Recent Advances Of Fungal Diagnostics In Asian Laboratories

Share this
page



Share
this page

Professor Arunaloke Chakrabarti
Head
Department of Medical Microbiology
Postgraduate Institute of Medical Education and Research
Chandigarh, India

Mortality due to invasive fungal infection is up to 100% if not treated and about 50% even with proper treatment. The poor outcome is attributed to absence of diagnosis due to nonspecific clinical signs and symptoms. Common clinical situations include inappropriate use of broad-spectrum antibacterial drugs in inaccurately diagnosed fungal sepsis and failure to diagnose chronic pulmonary aspergillosis in smear-negative pulmonary tuberculosis, among others.1 These scenarios point to the importance of access to advanced fungal diagnostics to improve clinical outcomes, promote antimicrobial stewardship and control antimicrobial resistance.

Current methods detect clinical infection

Currently available methods include T2 magnetic resonance for detection of candidemia,2 molecular identification of the fungus in the tissue – immunohistochemistry, DNA sequencing and fluorescence in situ hybridization (FISH)3 and the proteomic-based matrix-assisted laser desorption ionization (MALDI) for the identification of various fungi.4 These methods, however, are only able to detect pathogens upon clinical infection. Improvement of outcomes, however, will rely on detection at biological infection and prompt administration of targeted prophylaxis or pre-emptive therapy.

New diagnostic tests

Several new prospective diagnostic tests have been developed in recent years, each with their own pros and cons. These include the combination of polymerase chain reaction (PCR) and galactomannan tests,5 proximity ligation assay,6 detection of siderophore production6 and electronic nose technology for Aspergillus detection,7 and cryptococcal antigen lateral flow assay.8 These methods have various rates of success and need further validation. Current consensus for diagnostic tests serves as a guide for choosing appropriate methods (Table). 

Table. Current consensus on diagnostic tests for fungal infections

Infection

Culture/
histopathology

Biomarker (antibody)

Biomarker (antigen)

Response to treatment

Aspergillosis

Yes – invasive

No

GM/BDG/PCR

Increasing evidence

Cryptococcosis

Routine

No

Antigen/PCR

Yes (CSF antigen)

Histoplasmosis

Culture – delay

Limited

Antigen

Yes (antigen)

Mucormycosis

Yes – invasive

No

Investigational

No

Other molds

Yes – invasive

No

Investigational

No

Candidiasis

Routine

Investigational (anti-mannan)

PCR/mannan/BDG  

No

BDG, β-D-glucan; CSF, cerebrospinal fluid; GM, galactomannan; PCR, polymerase chain reaction    

Present scenario in Asian countries

A recent study involving 241 laboratories in 7 Asian countries revealed poor access to biomarker tests like galactomannan, β-D-glucan and PCR in Indonesia, the Philippines and Thailand.9 The authors called for the need for the development of quality laboratories, accreditation and training of manpower in existing laboratories, as well as access to advanced non–culture-based diagnostic tests for improved diagnosis of fungal infections in Asia.  

Highlights of the Medical Mycology Training Network Conference, August 5–6, 2017, Kuala Lumpur, Malaysia.

References

  1. Denning DW, et al. Emerg Infect Dis 2017;177-183.
  2. Beyda ND, et al. Diagn Microbiol Infect Dis 2013;77:324-326.
  3. Zaman K, et al. J Med Microbiol 2017;66:1124-1129.
  4. Ghosh AK, et al. Clin Microbiol Infect 2015;21:372-378.
  5. Arvanitis M, et al. Clin Infect Dis 2015;61:1263-1272.
  6. Johnson G, et al. Biomark Med 2014;8:429-451.
  7. de Heer K, et al. J Clin Microbiol 2013;1490-1495.
  8. Nalintya E, et al. Cur Fungal Infect Rep 2016;10:62-67.
  9. Chindamporn A, et al. Med Mycol 2017 [Epub ahead of print].   
SIGN UP FOR NEWSLETTER
SIGN UP

This field is required. Please enter your email address.
Thank you for signing up for the AFWG newsletter.
You have previously subscribed for AFWG newsletter.