ATS Releases New Guidelines on Diagnosing Fungal Infections

The American Thoracic Society has released a new clinical practice guideline on laboratory testing for the diagnosis of fungal infections in pulmonary and critical care practice.

The authors of the guidelines examined available literature on the diagnosis of invasive pulmonary aspergillosis, invasive candidiasis, and the common endemic mycoses and developed the guidelines using the Grading of Recommendations Assessment, Development, and Evaluation approach.

Among the recommendations:

• In severely immunocompromised patients, serum GM testing is recommended (strong recommendation, high-quality evidence).
• In patients with suspected invasive fungal diseases, BAL testing with GM is recommended (strong recommendation, high-quality evidence).
• In severely immunocompromised patients suspected of having IPA, blood or serum Aspergillus PCR testing is recommended (strong recommendation, high-quality evidence).
• In critically ill patients with a clinical concern for IC, do not rely solely on results of serum BDG testing for diagnostic decision-making (conditional recommendation, low-quality evidence).
• In patients with suspected community-acquired pneumonia, initial serological testing with close clinical follow-up and serial testing is recommended (conditional recommendation, moderate-quality evidence).

“With the rising incidence of invasive fungal infections in both immunocompromised and immunocompetent patients, the clinician should become familiar with the application of relevant laboratory testing outlined in this guideline to confirm the diagnosis of these important infections.”

—Michael Potts

Reference:

Hage CA, Carmona EM, Epelbaum O, et al. Microbiological laboratory testing in the diagnosis of fungal infections in pulmonary and critical care practice. an official american thoracic society clinical practice guideline [published online September 1, 2019]. Am J Respir Crit. https://doi.org/10.1164/rccm.201906-1185ST