ATS Guideline Outlines Lab Tests for Diagnosis of Fungal Infections

Rapid and accurate diagnosis of fungal infections relies on appropriate use of diagnostic testing, according to the official American Thoracic Society clinical practice guideline published in the issue of the American Journal of Respiratory and Critical Care Medicine.

Chadi A. Hage, M.D., from the Mayo Clinic in Rochester, Minnesota, and colleagues examined evidence relevant to commonly available laboratory testing, including the use of specific antigen tests, serological assays, and polymerase chain reaction (PCR) testing for the diagnosis of fungal infections encountered in pulmonary and critical care practice.

The authors recommend the use of serum galactomannan (GM) antigen testing for patients with severe immunocompromise presenting with unexplained lung infiltrates who have a suspected diagnosis of invasive pulmonary aspergillosis (IPA). Bronchoalveolar lavage (BAL) testing with GM is recommended in patients with a suspected diagnosis of invasive fungal disease, including those with a negative GM but strong risk factors for invasive aspergillosis. Blood or serum Aspergillus PCR testing is recommended for patients with severe immunocompromise who are suspected of having IPA. Inclusion of Aspergillus PCR is recommended in BAL testing as part of the evaluation for patients with severe immunocompromise. When timely diagnosis and treatment are of paramount importance to outcome, testing for Histoplasma antigen in urine or serum is recommended for rapid diagnosis of suspected disseminated and acute pulmonary histoplasmosis.

"The clinician should become familiar with the application of relevant laboratory testing outlined in this guideline to confirm the diagnosis of these important infections," the authors write.

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