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Clinicians say: lack of diagnostic tests, or long TAT of tests, is a main issue when managing patients with suspected invasive fungal infections.
Evidence of sub-optimal mycology practice in UK laboratories
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 in their 2019 report ‘National mycology laboratory diagnostic capacity for invasive fungal diseases in 2017' (PMID: 31233810) included;
  • 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
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More Information 

​A collection of KEY articles on fungal diagnostics, tat's,  evaluations and antifungal stewardship
Non-culture based fungal diagnostics
The survey showed that fungal diagnostics were not available in most laboratories. β-D-Glucan was only available in 5% of responding laboratories, similarly Aspergillus serum galactomannan was only available in 21% and16% for BAL galactomannan. Aspergillus antibody testing was also mainly referred – as was Cryptococcal antigen testing – both 63%. 14% of laboratories performing Cryptococcus antigen test used lateral flow tests whilst 24% used an agglutination technique.

Opportunity for improvement
Detecting Aspergillus-specific antibodies:  Detecting aspergillus-specific IgG and IgM is critical to diagnosing chronic pulmonary aspergillosis (CPA). The LDBio product outperformed both ImmunoCAP and precipitins in a UK laboratory evaluations. This qualitative test requires no equipment and gives results in 10 minutes
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MORE INFORMATION

​Evaluations in tHE UK and france confirm the high sensitivity and specificity of this product as a screening tool for allergic  & chronic pulmonary aspergillosis 

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Opportunity for improvement
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Aspergillus antigen (galactomannan) for diagnosis of invasive aspergillosis.  Early rapid detection is a key factor in effective treatment. Detection of galactomannan in BAL fluid samples is a sensitive diagnostic method for Invasive Aspergillosis.    We can now offer ERA Biology Aspergillus galactomannan testing products.  This test is available as a rapid lateral flow assay(LFA) and as an EIA  in strip-well plates, which makes low number runs more economical.  A calibrated lateral flow reader is available which makes the LFA semi-quantitative.
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MORE INFORMATION

The lateral flow assay is supported by an optional reader making it semi-quantitative.
The eia is in strip well plates
Opportunity for improvement
(1-3)-β-D-Glucan.  ERA Biology's EIA is suitable for both serum and BAL samples.   The provision of 4 sets of reagents allows for more runs which makes the ERA Biology kit more economical for individual laboratories.
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MORE INFORMATION

​This test follows a protocol similar to other B-D- GLUCAN eias but strip-well plates and multiple reagent vials improve economy.
Antifungal Susceptibility Testing
Whilst 77% of respondent’s susceptibility test Candida spp. on-site, 81% referred Aspergillus susceptibility testing. Most respondents did not do susceptibility tests for Aspergillus isolated from patients on treatment. 13% tested where ABPA was involved, 16% for aspergilloma and 22% for chronic aspergillosis.Of the laboratories that test for antifungal susceptibility on Yeasts 57% used microdilution 43% used Vitek, 32% used E-test and 29% used disks. Of the 19% that did test Aspergillus 51% used microdilution, 31% used E-test and 43% used sequencing.
Opportunity for improvement
Susceptibility testing:  Many laboratories are sending yeasts and moulds to reference laboratories for susceptibility testing. Mean Turnaround -Time for yeasts quoted by one reference laboratory is 6 days whilst for moulds it quotes 8 days. In-house susceptibility testing of yeasts and moulds should be 1-2 days offering a significant area for improvement.
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MORE INFORMATION

bioconnections has been helping uk laboratories implement fungal  broth microdilution for several years
EUCAST; It is recommended that broth microdilution is used to perform antifungal susceptibility testing of yeasts.  are unique,  BioConnections have helped UK laboratories introduce MICRONAUT antimycotic broth microdilution products into their routine.

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  • Home page
  • Antibiotic Resistance
  • CHROMagar
  • Coris RESIST
  • Coris BioConcept ICT
  • Gonogen
  • MICROBIOLOGICS
  • MICRONAUT Broth Microdilution
    • yeasts&moulds
  • Mycology
  • Rosco Neo-sensitabs
  • REAL saliva
  • Rosco Phenotyping
  • Sifin Antisera
  • About
  • contact
  • TAT fungalDiagnostics
  • MBLo Bruker Controls