From the Guidelines
Pulmonary fungal infections can be detected using various laboratory tests, including serum galactomannan (GM) testing, bronchoalveolar lavage (BAL) testing with GM, serum antibody testing, and PCR-based assays.
Laboratory Tests for Pulmonary Fungal Infections
- Serum GM testing: recommended for patients with severe immunocompromise, such as those with neutropenia or hematological malignancy, presenting with unexplained lung infiltrates suspected of invasive pulmonary aspergillosis (IPA) 1
- BAL testing with GM: recommended for patients suspected of invasive fungal diseases, including those with a negative serum GM but strong risk factors for invasive aspergillosis or positive serum GM but confounding factors for false-positive GM results 1
- Serum antibody testing: recommended for patients with suspected blastomycosis, specifically directed against the anti–BAD-1 (anti–Blastomyces adhesin 1) antigen 1
- PCR-based assays: can be used in conjunction with other diagnostic tests, such as direct microscopy, histopathology, and culture, to diagnose fungal infections 1
Specific Tests for Different Fungal Infections
- Invasive pulmonary aspergillosis (IPA): serum GM testing, BAL testing with GM, and PCR-based assays can be used for diagnosis 1
- Blastomycosis: serum antibody testing specifically directed against the anti–BAD-1 (anti–Blastomyces adhesin 1) antigen can be used for diagnosis 1
- Coccidioidomycosis: multiple diagnostic tests, including direct visualization and culture of sputum BAL or other biopsy material, urine and serum antigen testing, and serology (serum antibody testing), can be used for diagnosis 1
- Mucormycosis: galactomannan detection is moderately supported for diagnosis, while 1,3-b-D-glucan testing is not recommended 1
From the Research
Laboratory Tests for Pulmonary Fungal Infections
The following laboratory tests are used to detect pulmonary fungal infections:
- Direct microscopic examination of secretions or body fluids 2
- Histopathologic examination of tissue biopsies 2
- Cultures of secretions, body fluids, or ground-up tissue 2
- Immunological tests, including serologic techniques such as immunodiffusion and complement fixation 3
- Molecular techniques, including nucleic acid probes, mass spectrometry-based methods, nucleic acid amplification testing, and traditional and broad-range sequencing 3
- Non-culture-based tests for the detection of galactomannan, β(1,3)-glucan, and an extracellular glycoprotein 4
- Labeled primer polymerase chain reaction for quantitative detection and differentiation of common pulmonary fungal pathogens 5
- Fluorescent in situ hybridization-based molecular methods for specific detection of fungal species 4
- Detection of antibodies, antigens, or nucleic acid for diagnosis of mycoses 6
- Search for galactomannan antigen and use of "Lateral Flow Device" for diagnosis of aspergillosis 6