Recognition of Diagnostic Gaps for Laboratory Diagnosis of Fungal Diseases: Expert Opinion from the Fungal Diagnostics Laboratories Consortium (FDLC) (original) (raw)

Abstract

Fungal infections are a rising threat to our immunocompromised patient population, as well as other nonimmunocompromised patients with various medical conditions. However, little progress has been made in the past decade to improve fungal diagnostics.

Figures (3)

FIG 1 Fungal diagnostic priorities associated with disease-specific and method/approach-specific diagnostic gaps. The figure illustrates identification of the five fungal diagnostic priorities associated six disease- and six method- specific diagnostic gaps that are further delineated in the commentary. FFPE, formalin fixed and _ paraffin embedded; MALDI-TOF MS, matrix-assisted laser desorption ionization-time of flight mass spectrometry.

FIG 1 Fungal diagnostic priorities associated with disease-specific and method/approach-specific diagnostic gaps. The figure illustrates identification of the five fungal diagnostic priorities associated six disease- and six method- specific diagnostic gaps that are further delineated in the commentary. FFPE, formalin fixed and _ paraffin embedded; MALDI-TOF MS, matrix-assisted laser desorption ionization-time of flight mass spectrometry.

TABLE 1 FDA-cleared methods for the rapid identification of Candida species in blood? 2FDA, Food and Drug Administration; PNA, peptide nucleic acid; FISH, fluorescent in situ hybridization; BCID, blood culture identification; SN, sensitivity; SP, specificity. The Yeast TrafficLight and T2Candida panel detected but could not differentiate C. albicans from C. parapsilosis or C. glabrata from C. krusei. The FilmArray BCID2 includes C. auris. dMinimal steps include sample pipetting only. Moderate steps may include pipetting, mixing, centrifugation, and/or slide preparation. *Accuracy in blood culture aliquot studies represents the overall agreement compared to a reference standard. For MALDI-TOF MS studies, species identification scores below the study’s stated threshold were cons incorrect. fSepsityper protocols vary across studies, and some reports have used laboratory-developed extraction methods. Sepsityper is CE marked but is not FDA cleared.

TABLE 1 FDA-cleared methods for the rapid identification of Candida species in blood? 2FDA, Food and Drug Administration; PNA, peptide nucleic acid; FISH, fluorescent in situ hybridization; BCID, blood culture identification; SN, sensitivity; SP, specificity. The Yeast TrafficLight and T2Candida panel detected but could not differentiate C. albicans from C. parapsilosis or C. glabrata from C. krusei. The FilmArray BCID2 includes C. auris. dMinimal steps include sample pipetting only. Moderate steps may include pipetting, mixing, centrifugation, and/or slide preparation. *Accuracy in blood culture aliquot studies represents the overall agreement compared to a reference standard. For MALDI-TOF MS studies, species identification scores below the study’s stated threshold were cons incorrect. fSepsityper protocols vary across studies, and some reports have used laboratory-developed extraction methods. Sepsityper is CE marked but is not FDA cleared.

TABLE 2 Summary of fungal disease-specific and method/approach-specific diagnostic gaps and proposals to fill the gaps? “AST, antifungal susceptibility testing; BDG, 1,3-8-p-glucan; CF, cystic fibrosis; FFPE, formalin fixed and paraffin embedded; GM, galactomannan; ID, identification; NAAT, nucleic acid amplification test; qNAAT, quantitative NAAT; POCT, point-of-care test; +, available; —, not available.

TABLE 2 Summary of fungal disease-specific and method/approach-specific diagnostic gaps and proposals to fill the gaps? “AST, antifungal susceptibility testing; BDG, 1,3-8-p-glucan; CF, cystic fibrosis; FFPE, formalin fixed and paraffin embedded; GM, galactomannan; ID, identification; NAAT, nucleic acid amplification test; qNAAT, quantitative NAAT; POCT, point-of-care test; +, available; —, not available.

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