Diagnostik bei invasiven Mykosen: What’s hot?

Invasive Pilzinfektionen sind eine wesentliche Ursache für Morbidität und Letalität bei Patient*innen mit Abwehrschwäche. Die wichtigsten und häufigsten Pathogene in Europa sind Aspergillus- und Candida-Spezies. Zunehmend werden aber auch Mucorales-, Trichosporon- und Fusarium-Spezies nachgewiesen. Die gesicherte Diagnose einer invasiven Mykose ist schwierig. Neben Bildgebung und Klinik sind Grundelemente der Diagnostik die konventionelle Pilzkultur, Mikroskopie, Antikörper-/Antigen-Suchtests und Molekularbiologie.

Abstract

Invasive fungal infections are a significant cause of morbidity and mortality in immunocompromised patients. The primary and most frequent pathogens in Europe are Aspergillus and Candida species. However, other representatives such as Mucorales, Trichosporon, and Fusarium species are increasingly being identified. Confirming the diagnosis of an invasive mycosis is challenging; apart from imaging and clinical presentation, essential diagnostic elements include conventional fungal culture, microscopy, antibody/antigen detection tests, and molecular biology.

Kernaussagen

• Die Auswahl diagnostischer Tests hängt in der Regel von der Patientenpopulation, der Vortest-Wahrscheinlichkeit der Infektionskrankheit, der Laborausstattung und der regionalen Expertise ab.

• Es gibt keinen einzelnen Test, der alle diagnostischen Anforderungen erfüllt und alle Pilze abdeckt, daher wird ein „Puzzle-Diagnoseansatz“ empfohlen.

• Biomarker werden verwendet, um bei der Diagnose zu unterstützen, anstatt eine endgültige Diagnose festzustellen.

• Prinzipiell sind Biomarker nur bei Risikopatient*innen bzw. bei Verdacht auf eine spezielle Infektion einzusetzen. Alle Ergebnisse müssen im Kontext einer Erkrankung gesehen werden.

• Der Einsatz diagnostischer Tests und deren korrekte Interpretation sollten im Rahmen eines „Antibiotic-Stewardships“ festgelegt werden.

Schlüsselwörter

nvasive Pilzinfektionen - Diagnostik - Mikroskopie - Biomarker

Keywords

invasive mycoses - diagnostics - fungal microscopy - biomarker

Publication History

Article published online:
24 April 2024

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