GUIDELINES FOR THE INVESTIGATION OF INVASIVE FUNGAL-INFECTIONS IN HEMATOLOGICAL MALIGNANCY AND SOLID-ORGAN TRANSPLANTATION

Invasive fungal infections are increasing in incidence and now affect as many as 50% of neutropenic/bone marrow transplant patients and 5 to 20% of solid organ transplant recipients. Unfortunately, many of the diagnostic tests available have a low sensitivity. The guidelines pres ented here have been produced by a working party of the British Societ y for Medical Mycology in an attempt to optimise the use of these test s. The yield of fungi from blood cultures can be increased by ensuring that at least 20 mi of blood are taken for aerobic culture, by using more than one method of blood culture, and by employing terminal subcu lture if continuous monitoring systems are used with a five-day incuba tion protocol, Skin lesions in febrile neutropenic patients should be biopsied and cultured for fungi. The detection of galactomannan in blo od or urine is of value in diagnosing invasive aspergillosis only if t ests are performed at least twice weekly in high-risk patients. Antige n detection tests for invasive candidiasis are less valuable, Computed tomography scanning is particularly valuable in diagnosing invasive p ulmonary fungal infection when the chest radiograph is negative or sho ws only minimal changes. Bronchoalveolar lavage is most useful in pati ents with diffuse changes on computed tomography scan. The major advan ces in the diagnosis of invasive fungal infection in patients with hae matological malignancy or solid organ transplantation have been in the use of imaging techniques, rather than in the development of new myco logical methods in the routine laboratory.