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

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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.

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Authors and Affiliations

  1. Department of Infectious Diseases and Tropical Medicine (Monsall Unit), North Manchester General Hospital, M8 5RB, Manchester, UK

    D. W. Denning

  2. Department of Medical Mycology, PHLS Mycology Reference Laboratory, Department of Microbiology, University of Leeds, UK

    E. G. V. Evans

  3. Department of Medical Microbiology, Royal Free Hospital, Pond Street, NW3 2QG, London, UK

    C. C. Kibbler

  4. Department of Dermatology, Regional Mycology Reference Laboratory, University of Glasgow, UK

    M. D. Richardson

  5. University Department of Dermatology, Hope Hospital, M6 8MD, Salford, UK

    M. M. Roberts

  6. Department of Infectious Diseases and Bacteriology, Royal Postgraduate Medical School, London, UK

    T. R. Rogers

  7. Public Health Laboratory, PHLS Mycology Reference Laboratory, Bristol, UK

    D. W. Warnock

  8. Public Health Laboratory, Royal Shrewsbury Hospital, UK

    R. E. Warren

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  1. D. W. Denning
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Denning, D.W., Evans, E.G.V., Kibbler, C.C. et al. Guidelines for the investigation of invasive fungal infections in haematological malignancy and solid organ transplantation. Eur. J. Clin. Microbiol. Infect. Dis. 16, 424–436 (1997). https://doi.org/10.1007/BF02471906

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