Research Article| Volume 47, ISSUE 3, P257-269, April 2015

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Molecular diagnostic methods for invasive fungal disease: the horizon draws nearer?

  • C.L. Halliday
    Clinical Mycology Reference Laboratory, Centre for Infectious Diseases and Microbiology Laboratory Services, ICMPR – Pathology West, Westmead Hospital, NSW, Australia

    Centre for Infectious Diseases and Microbiology, Westmead Millennium Institute, NSW, Australia
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  • S.E. Kidd
    National Mycology Reference Centre, SA Pathology, SA, Australia
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  • T.C. Sorrell
    Centre for Infectious Diseases and Microbiology, Westmead Millennium Institute, NSW, Australia

    Marie-Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, NSW, Australia
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  • S.C.-A. Chen
    Address for correspondence: Centre for Infectious Diseases, Microbiology Laboratory Services, ICPMR – Pathology West, Level 3, ICPMR Building, Westmead Hospital, Darcy Road, NSW 2145, Australia.
    Clinical Mycology Reference Laboratory, Centre for Infectious Diseases and Microbiology Laboratory Services, ICMPR – Pathology West, Westmead Hospital, NSW, Australia

    Centre for Infectious Diseases and Microbiology, Westmead Millennium Institute, NSW, Australia
    Search for articles by this author
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      Rapid, accurate diagnostic laboratory tests are needed to improve clinical outcomes of invasive fungal disease (IFD). Traditional direct microscopy, culture and histological techniques constitute the ‘gold standard’ against which newer tests are judged. Molecular diagnostic methods, whether broad-range or fungal-specific, have great potential to enhance sensitivity and speed of IFD diagnosis, but have varying specificities. The use of PCR-based assays, DNA sequencing, and other molecular methods including those incorporating proteomic approaches such as matrix-assisted laser desorption ionisation-time of flight mass spectroscopy (MALDI-TOF MS) have shown promising results. These are used mainly to complement conventional methods since they require standardisation before widespread implementation can be recommended. None are incorporated into diagnostic criteria for defining IFD. Commercial assays may assist standardisation. This review provides an update of molecular-based diagnostic approaches applicable to biological specimens and fungal cultures in microbiology laboratories. We focus on the most common pathogens, Candida and Aspergillus, and the mucormycetes. The position of molecular-based approaches in the detection of azole and echinocandin antifungal resistance is also discussed.

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