Diagnosing invasive fungal disease in critically ill patients

Abstract

Fungal infections are increasing, with a changing landscape of pathogens and emergence of new groups at risk for invasive disease. We review current diagnostic techniques, focusing on studies in critically ill patients. Microbiological cultures, the current “gold standard”, demonstrate poor sensitivity, thus diagnosis of invasive disease in the critically ill is difficult. This diagnostic dilemma results in under- or over-treatment of patients, potentially contributing to poor outcomes and antifungal resistance. While other current diagnostic tests perform moderately well, many lack timeliness, efficacy, and are negatively affected by treatments common to critically ill patients. New nucleic acid-based research is promising.

Keywords::

• Intensive care unit
• diagnosis
• invasive mycoses
• Aspergillus
• Candida

Acknowledgements

We thank Dr. Michele Tang for information regarding the cryptococcal LFD. We also thank Dr. Karl Clemons for his critical review of the manuscript.

Declaration of Interests

The authors report no declarations of interest. David Stevens, Joe Hsu, and Mark Holodniy are supported in part by NIAID/NIH grant [R21 AI 85566-01, Dr. David Stevens, PI].