DIAGNOSIS OF INVASIVE MYCOSES IN SEVERELY IMMUNOSUPPRESSED PATIENTS

In compromised patients, invasive mycoses are being observed at an inc reasing frequency and with a broadening spectrum of causative fungi. T he rapid and definitive diagnosis of such opportunistic mycoses requir es the synoptical consideration of predisposing clinical conditions, o f culture isolates, and of the results of nonculture techniques. At pr esent, the latter comprise the monitoring of specific antibodies and o f fungal antigens, and the microscopical examination of suspected biop sies. The validity of the individual techniques (e.g., the monitoring of antibodies or antigens) varies with individual mycoses. Alternative methods for monitoring fungal metabolites or nucleic acids are still in the developmental stage. Particularly the amplification of DNA by t he polymerase chain reaction (PCR) has a high diagnostic potential. Ho wever, at present, it is uncertain whether PCR allows the necessary di stinction between colonization and truly invasive infection, and wheth er PCR can be simplified sufficiently to allow the continuous surveill ance of high-risk patients.