New strategies for the microbiological diagnosis of visceral mycoses
Nouvelles strategies pour le diagnostic microbiologique des mycoses viscerales
Résumé
The recent improvements of the diagnosis of invasive mycoses have included the shortening of the species identification time for a rapid adaptation of the antifungal treatment, and the anticipation of the diagnosis thanks to biomarkers. Species identification is now achieved using MALDI-TOF 24 hours earlier than with the previous phenotypic tests. The aim is now to identify directly on positive blood bottle either using MALDI-TOF or molecular methods. The biomarkers are dominated by antigens (mannan, galactomanan, glucan) with available commercial kits. These antigens are mainly used as screening tests in patients at risk of invasive mycoses. Their main limitation is their weak specificity rather than their sensitivity. For circulating DNA, the quantitative real-time PCR format and the publication of recommendations for validation of diagnostic assays suggest they should be implemented soon in a diagnostic strategy.