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Current Challenges in the Microbiological Diagnosis of Invasive Aspergillosis

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Abstract

The diagnosis of invasive aspergillosis is challenging because no sufficiently sensitive or specific tests have been developed to date. Infection can only be confirmed using histology, although this approach is unavailable in many patients. Therefore, diagnosis of invasive aspergillosis is based on a combination of the presence of host factors, radiological and clinical findings, and mycological criteria. In clinical practice, lack of optimal diagnostics often leads to empirical therapy and great cost and toxicity. Mycological criteria include the isolation of Aspergillus from clinical samples or the detection of biomarkers in fluids. Culture is cheap and easy and enables the identification of fungi and performance of antifungal susceptibility testing; however, it has low sensitivity and specificity. Non-culture-based diagnosis is based on the detection of fungal biomarkers such as galactomannan or (1 → 3)-β-d-glucan in normally sterile body fluids. These procedures enable faster and more sensitive and specific detection of Aspergillus; however, diagnostic accuracy is affected by the patient’s underlying condition. Finally, while detection of Aspergillus DNA is promising, the lack of standardization limits its inclusion as a mycological criterion for the definition of probable invasive aspergillosis. New diagnostic procedures based on lateral flow technology are also promising but need further evaluation. In the present review, we discuss current culture-based and non-culture-based procedures for the microbiological diagnosis of invasive aspergillosis.

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Acknowledgments

We would like to thank Thomas O’Boyle for editing and proofreading the article. Jesús Guinea is supported by the Fondo de Investigación Sanitaria (MS09/00055).

Conflict of interest

This study does not present any conflict of interest for its authors.

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Authors and Affiliations

  1. Servicio de Microbiología Clínica y Enfermedades Infecciosas, Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, C/Dr. Esquerdo, 46, 28007, Madrid, Spain

    Jesús Guinea & Emilio Bouza

  2. Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Madrid, Spain

    Jesús Guinea & Emilio Bouza

  3. CIBER de Enfermedades Respiratorias (CIBER RES CB06/06/0058), Madrid, Spain

    Jesús Guinea & Emilio Bouza

  4. Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain

    Jesús Guinea & Emilio Bouza

Authors
  1. Jesús Guinea
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  2. Emilio Bouza
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Correspondence to Jesús Guinea.

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Guinea, J., Bouza, E. Current Challenges in the Microbiological Diagnosis of Invasive Aspergillosis. Mycopathologia 178, 403–416 (2014). https://doi.org/10.1007/s11046-014-9763-3

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  • DOI: https://doi.org/10.1007/s11046-014-9763-3

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