UK Laboratories are unprepared
In recent years there have been increasing reports of invasive fungal disease and the emergence of more intrinsically resistant species of pathogenic fungi, such as Candida auris. ESPAUR initiated an analysis of current practices in diagnosis and treatment of mycological infections. Key findings published the 2019 report ‘National mycology laboratory diagnostic capacity for invasive fungal diseases in 2017;
A report commented under ‘Highlights’
In recent years there have been increasing reports of invasive fungal disease and the emergence of more intrinsically resistant species of pathogenic fungi, such as Candida auris. ESPAUR initiated an analysis of current practices in diagnosis and treatment of mycological infections. Key findings published the 2019 report ‘National mycology laboratory diagnostic capacity for invasive fungal diseases in 2017;
A report commented under ‘Highlights’
- There is a need to improve the UK diagnostic capacity for invasive fungal diseases.
- A minority of laboratories have local access to β-glucan and galactomannan testing
- Susceptibility testing of Aspergillus is currently conducted by few laboratories
| journal_of_inection_2019_sub-optimal.pdf |
Can we improve TAT for fungal disease diagnostics?
A second report, 'An investigation of antifungal stewardship programmes in England' included the following comments;
'There is an urgent need to improve across many diagnostic areas including the timely accessibility of/to fungal biomarkers and susceptibility testing.'
'Clinicians say: lack of diagnostic tests or long TAT’s of tests is a main issue when managing patients with suspected invasive fungal infections.'
A second report, 'An investigation of antifungal stewardship programmes in England' included the following comments;
'There is an urgent need to improve across many diagnostic areas including the timely accessibility of/to fungal biomarkers and susceptibility testing.'
'Clinicians say: lack of diagnostic tests or long TAT’s of tests is a main issue when managing patients with suspected invasive fungal infections.'
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Can we reduce empirically prescribed antifungal treatments?
The availability of rapid diagnostics and in-house EUCAST broth microdilution will help create an AFS programme. The Pharmaceutical Journal, July 2019, Vol 303, No 7927, online |
NHS Antifungal Stewardship Implementation Pack
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How Long is Too Long? Fungal biomarker turn-around-time (TAT) and antifungal stewardship.
A median turn-around time of 1-2 weeks significantly devalues the use of fungal biomarkers
A median turn-around time of 1-2 weeks significantly devalues the use of fungal biomarkers
| fungal_biomarker_turn-around-time__tat__and_antifungal_stewardship__how_long_is_too_long____aspergillus___aspergillosis_website.pdf |
Fungal Disease Diagnostics from BioConnections
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LDBIO The National Aspergillosis Centre in Manchester, UK has tested their LFA device for Aspergillus antibody and found it to be accurate, identifying 91% of cases of Chronic Pulmonary Aspergillosis in 30min.
ERA Biology A pioneer in products for invasive fungal disease diagnosis. Products include Aspergillus galactomannan, Beta-D-Glucan,and Cryptococcal capsular polysaccharide in LFA, EIA & PCR formats.
MICRONAUT Broth microdilution is the technique that should be used for antifungal susceptibility according to EUCAST. This product has been evaluated and is in use in leading UK hospitals.
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Invasive Aspergillosis KEY PUBLICATIONS
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COVID-19 associated invasive aspergillosis: data from the UK National Mycology Reference Laboratory. From the discussion 'In addition to radiological imaging, serial screening for CAPA (CoVID Associated Pulmonary Aspergillosis) in ICU patients with deteriorating respiratory function should include: (i) regular (at least weekly) Aspergillus antigen testing of serum samples, (ii) regular (at least weekly) BDG testing of serum samples , (iii) Aspergillus antigen testing of BAL fluids (where available) or non -directed lavages/tracheal aspirates and (iv) Aspergillus PCR in conjunction with conventional mycological examination (microscopy and culture) of respiratory secretions if available. '
Invasive fungal disease occurs often in critically ill patients with COVID-19 on mechanical ventilation, according to a study published in Clinical Infectious Diseases.
A national strategy to diagnose COVID-19 associated invasive fungal disease in the ICU
Confronting and mitigating the risk of COVID-19 Associated Pulmonary Aspergillosis (CAPA)
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Pulmonary Aspergillosis KEY PUBLICATIONS
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Chronic Pulmonary Aspergillosis—Where Are We? and Where Are We Going?
'The use of Aspergillus IgG antibody as a diagnostic tool is far superior to the use of Aspergillus precipitins and should always be used as the gold standard ..to confirm infection.' J. Fungi 2016, 2(2), 18; https://doi.org/10.3390/jof2020018 Evaluation of LDBio Aspergillus ICT Lateral Flow Assay for IgG and IgM Antibody Detection in Chronic Pulmonary Aspergillosis
Precis; The LDBIO Aspergillus ICT IgG-IgM immunochromatographic technology (ICT) test was compared with Aspergillus IgG titers in CPA patients, measured by ImmunoCAP-specific IgG assays (cutoff value, 40 mg of antigen-specific antibodies [mgA]/liter For proven CPA patients versus controls, sensitivity and specificity for the LDBio Aspergillus ICT were 91.6% and 98.0%, respectively. In contrast, the routinely used ImmunoCAP assay exhibited 80.5% sensitivity for the same cohort Of the 154 patients in our CPA case group, 108 had precipitins testing (for Aspergillus antibody) performed as part of routine diagnostics, with 57.4% sensitivity. |
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Evaluation of the LDBio Aspergillus ICT lateral flow assay for serodiagnosis of allergic bronchopulmonary aspergillosis.
Precis; Early recognition and diagnosis of allergic bronchopulmonary aspergillosis (ABPA) is critical to improve patient symptoms, and antifungal therapy may prevent or delay progression of bronchiectasis and development of chronic pulmonary aspergillosis. ABPA and control sera collected at the National Aspergillosis Centre (Manchester, UK) and/or from the Manchester Allergy, Respiratory and Thoracic Surgery research biobank were evaluated using the Aspergillus ICT assay. Results were read both visually and digitally (using a lateral flow reader). Serological Aspergillus-specific IgG and IgE, and total IgE titres were measured by ImmunoCAP. . The test effectively distinguished between Aspergillus-sensitization complicating asthma and/or bronchiectasis, and underlying conditions. It is rapid (result in <30 minutes) and easy to perform, with simple result interpretation by visible inspection. Overall, the LDBio Aspergillus ICT exhibits excellent performance as a screening tool in the ABPA diagnostic pathway Published: September 25, 2020 https://doi.org/10.1371/journal.pone.0238855 |
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Towards an Antifungal Stewardship Programme KEY PUBLICATIONS
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An investigation of antifungal stewardship programmes in England. ..Cost issues are the main driver for AFS, followed by clinical need. The availability of rapid diagnostics and clinical support could help increase AFS initiatives. Availability of rapid diagnostics and clinical support would help create an AFS programme.
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Utility of 1,3 β-d-Glucan Assay for Guidance in Antifungal Stewardship Programs for Oncologic Patients and Solid Organ Transplant Recipients. 'the determination of BDG in SOT recipients and oncological patients is a tool that can be used to stop empirical prescribed AF treatments or to confirm the diagnosis of IFI. This is a cost-effective strategy that safely improves the results of an ASP based on bedside advice in a tertiary care hospital.'
Antifungal Stewardship Implementation Pack This pack provides information and guidance to support the local implementation of this Improving Value initiative. A checklist included that can be used to check local readiness for implementation.
Comparative Evaluation of Micronaut-AM and CLSI broth microdilution method for antifungal susceptibility testing of Aspergillus species against four commonly used antifungals.
Ali Nuh, Newara Ramadan, Silke Schelenz, Darius Armstrong-James. doi: https://doi.org/10.1101/811901 |
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