Invasive Fungal Infections: Diagnosis and Treatments in China

Ran, Yuping

Abstract

The body location and clinical appearance of fungal infections depends on the fungal virulence, infectious route and host immunological state. The result being that patients with mycoses consult with different clinical departments. The diagnosis of mycoses is based on the detection of fungal elements such as hyphae and/or yeast cells from the involved tissues. Isolation of the fungus is the precondition for species identification and antifungal treatment. To think clinically and to emphasize the mycology is the basic consideration of medical mycology research. Mycologists play a key role in the collaboration between the clinical and laboratory aspects. The clinician always wants to know what the fungus is and how to treatment the mycosis. Fungal pathogens are often stealthy and difficult to detect in infected patients during the early stages of the diseases and this is when therapies would be the most effective. Routine techniques commonly employed in the detection of fungal diseases including microscopic examination, culturing and serology are seriously hampered by lengthy waits of times for results and low accuracy. The clinician may want prophylaxis or to use empirical antifungal treatment to see if it does/does not work. The problem is that some of the patients do not respond to the antifungal treatment, because the doctor lacked sufficient evidence of fungus infection to give the doctor confidence to continue treatment. Accurate and early diagnosis of fungal diseases is critical for managing mycotic diseases. This is usually done by direct microscopic examination (DME) of KOH preparations. Good specimens are the key point that directly affects the quality of microscopic evidence and culture. The most important aspect is culturing samples on different media with or without chloramphenicol and cycloheximide and incubated at room temperature and 37degrees C. Early treatment could save a patient's life. We start treatment at the time we have the proof of fungal infection, i.e., KOH positive. Itraconazole, fluconazole, terbinafine, amphotericin B or its liposome form, can be used alone or in combination based on the fungal species involved and the site of infection.