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2017 ; 6
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Challenges in microbiological diagnosis of invasive Aspergillus infections
#MMPMID28299183
Alanio A
; Bretagne S
F1000Res
2017[]; 6
(ä): ä PMID28299183
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Invasive aspergillosis (IA) has been increasingly reported in populations other
than the historical hematology patients and there are new questions about the
performance of microbiological tools. Microscopy and culture have been completed
by biomarkers, either antigens or DNA, and in blood or respiratory specimens or
both. First studied in hematology, the antigen galactomannan performance in serum
is low in other patient populations where the pathophysiology of the infection
can be different and the prevalence of IA is much lower. DNA detection with
polymerase chain reaction (PCR) in blood or serum (or both) has reached a certain
level of acceptance thanks to consensus methods based on real-time quantitative
PCR (qPCR). When used on respiratory specimens, galactomannan and qPCR depend on
standardization of the sampling and the diverse mycological procedures. Thus,
culture remains the main diagnostic criterion in critically ill patients. The
current trend toward more effective anti-mold prophylaxis in hematology hampers
the yield of a screening strategy, as is usually performed in hematology.
Therefore, circulating biomarkers as confirmatory tests should be considered and
their performance should be reappraised in each new setting. The use of azole
prophylaxis also raises the issue of selecting azole-resistance Aspergillus
fumigatus isolates. Ideally, the biomarkers will be more efficient when
individual genetic risks of IA are defined. Culture, though not standardized,
remains a key element for the diagnosis of IA and has the advantage to easily
detect molds other than A. fumigatus. It is still unclear whether next-generation
sequencing will replace culture in the future.