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Diagnostic Immunology

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Diagnosis and Treatment of Fungal Infections

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Abstract

The frequency of invasive fungal infections has risen dramatically in recent decades, mostly because of a larger population of at-risk patients who are immunocompromised, neutropenic, or critically ill. For clinicians evaluating these patients, it has become increasingly important to make the diagnosis early so that timely antifungal therapy can be instituted. While histopathology and culture for the causative fungus are required for a definitive diagnosis, adequate tissue samples from protected anatomical sites are not always available and culture may lack sensitivity and require several weeks for results to become available. Thus, immunodiagnosis has become an important adjunctive strategy to diagnose most of the clinically relevant fungi. Many immunodiagnostic methods have been developed and generally target three important aspects of the infection: host antibody, fungal antigen, and fungal metabolites.

This chapter outlines the available immunologic tests according to what component of the invading pathogen or host immune response they target and provides some discussion of their strengths and weaknesses. In addition to a review of pan-fungal testing using 1,3-β-D-glucan, the discussion is focused on the following diseases: invasive candidiasis, invasive aspergillosis, cryptococcosis, histoplasmosis, blastomycosis, coccidioidomycosis, and paracoccidioidomycosis. Recommendations for utilizing the currently available immunodiagnostic tests are discussed for individual fungal species and specific disease manifestations.

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Authors and Affiliations

  1. Division of Infectious Diseases, Department of Medicine, Oregon Health and Science University, Portland, OR, USA

    Michael Conte, Christopher D. Pfeiffer & Brian Wong

  2. Division of Hospital and Specialty Medicine, Portland VA Medical Center, Portland, OR, USA

    Christopher D. Pfeiffer

  3. Division of Geographic Medicine and Infectious Diseases, Department of Medicine, Tufts University School of Medicine, Boston, MA, USA

    Brian Wong

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  1. Michael Conte
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Correspondence to Christopher D. Pfeiffer .

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  1. Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA

    Duane R. Hospenthal

  2. Departments of Pathology, Microbiology, and Clinical Laboratory Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA

    Michael G. Rinaldi

  3. Departments of Medicine and Microbiology & Immunology, University of Maryland School of Medicine, Baltimore, MD, USA

    Thomas J. Walsh

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Conte, M., Pfeiffer, C.D., Wong, B. (2023). Diagnostic Immunology. In: Hospenthal, D.R., Rinaldi, M.G., Walsh, T.J. (eds) Diagnosis and Treatment of Fungal Infections. Springer, Cham. https://doi.org/10.1007/978-3-031-35803-6_6

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