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Guidelines for the investigation of invasive fungal infections in haematological malignancy and solid organ transplantation

  • D. W. Denning
  • E. G. V. Evans
  • C. C. Kibbler
  • M. D. Richardson
  • M. M. Roberts
  • T. R. Rogers
  • D. W. Warnock
  • R. E. Warren
Article

Abstract

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 presented here have been produced by a working party of the British Society for Medical Mycology in an attempt to optimise the use of these tests. The yield of fungi from blood cultures can be increased by ensuring that at least 20 ml of blood are taken for aerobic culture, by using more than one method of blood culture, and by employing terminal subculture if continuous monitoring systems are used with a five-day incubation protocol. Skin lesions in febrile neutropenic patients should be biopsied and cultured for fungi. The detection of galactomannan in blood or urine is of value in diagnosing invasive aspergillosis only if tests are performed at least twice weekly in highrisk patients. Antigen detection tests for invasive candidiasis are less valuable. Computed tomography scanning is particularly valuable in diagnosing invasive pulmonary fungal infection when the chest radiograph is negative or shows only minimal changes. Bronchoalveolar lavage is most useful in patients with diffuse changes on computed tomography scan. The major advances in the diagnosis of invasive fungal infection in patients with haematological malignancy or solid organ transplantation have been in the use of imaging techniques, rather than in the development of new mycological methods in the routine laboratory.

Keywords

Aspergillosis Invasive Aspergillosis Invasive Fungal Infection Clinical Microbiology Invasive Candidiasis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© MMV Medizin Verlag GmbH 1997

Authors and Affiliations

  • D. W. Denning
    • 1
  • E. G. V. Evans
    • 2
  • C. C. Kibbler
    • 3
  • M. D. Richardson
    • 4
  • M. M. Roberts
    • 5
  • T. R. Rogers
    • 6
  • D. W. Warnock
    • 7
  • R. E. Warren
    • 8
  1. 1.Department of Infectious Diseases and Tropical Medicine (Monsall Unit)North Manchester General HospitalManchesterUK
  2. 2.Department of Medical Mycology, PHLS Mycology Reference Laboratory, Department of MicrobiologyUniversity of LeedsUK
  3. 3.Department of Medical MicrobiologyRoyal Free HospitalLondonUK
  4. 4.Department of Dermatology, Regional Mycology Reference LaboratoryUniversity of GlasgowUK
  5. 5.University Department of DermatologyHope HospitalSalfordUK
  6. 6.Department of Infectious Diseases and BacteriologyRoyal Postgraduate Medical SchoolLondonUK
  7. 7.Public Health LaboratoryPHLS Mycology Reference LaboratoryBristolUK
  8. 8.Public Health LaboratoryRoyal Shrewsbury HospitalUK

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