British Society for Medical Mycology best practice recommendations for the diagnosis of serious fungal diseases

Author: 

Silke Schelenz, Rosemary A Barnes, Richard C Barton, Joanne R Cleverley, Sebastian B Lucas, Christopher C Kibbler, David W Denning, on behalf of the British Society for Medical Mycology
Lancet Infect Dis. 2015 Apr;15(4):461-474.

Abstract: 

Invasive fungal diseases are an important cause of morbidity and mortality in a wide range of patients, and early diagnosis and management are a challenge. We therefore did a review of the scientifi c literature to generate a series of key recommendations for the appropriate use of microbiological, histological, and radiological diagnostic methods for diagnosis of invasive fungal diseases. The recommendations emphasise the role of microscopy in rapid diagnosis and identifi cation of clinically signifi cant isolates to species level, and the need for susceptibility testing of all Aspergillus spp, if treatment is to be given. In this Review, we provide information to improve understanding of the importance of antigen detection for cryptococcal disease and invasive aspergillosis, the use of molecular (PCR) diagnostics for aspergillosis, and the crucial role of antibody detection for chronic and allergic aspergillosis. Furthermore, we consider the importance of histopathology reporting with a panel of special stains, and emphasise the need for urgent (<48 hours) and optimised imaging for patients with suspected invasive fungal infection. All 43 recommendations are auditable and should be used to ensure best diagnostic practice and improved outcomes for patients.