[Serological diagnostic options in invasive fungal infections].

Abstract

The early diagnosis of invasive fungal infections (including Candida spp., Aspergillus spp., Pneumocystis jirovecii, Cryptococcus spp.) and their differentiation from non-invasive colonization is an important but seldom easy task. The measurement of fungal cell wall compounds (glucans and mannans) in body fluids (primarily sera) can provide us with useful information without putting more invasive burden on the patient. Galactomannan antigens of the Aspergillus cell wall are detected by classical serological methods. 1,3-β-D-glucans are fundamental compounds of the cell walls of almost all fungi with the exceptions of Zygomycetes and Cryptococcus spp. The coagulation or modified, but principally similar biochemical cascade of the Atlantic horseshoe crab lyzed amoebocytes became the standard method for their detection, that is a process beyond classical serology (as it lacks an antigen-antibody bond). Numerous new or improved methods and test kits have become available in the market for the measurement of both galactomannan and 1,3-β-D-glucans since the latest updates of the European and American diagnostic guidelines. We believe that summarizing the recent changes in diagnostic utilities for the Hungarian medical community might prove helpful in making a more informed and conscious diagnostic choice. In our work, we also aim to cover the possible additional antigen- and antibody-based test options that may be relevant in temperate climates. Orv Hetil. 2024; 166(7): 243–252.