Guideline: The American Thoracic Society provides recommendations for the diagnosis of fungal infections.
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. Am J Respir Crit Care Med. 2019 Sep 1;200(5):535-550. doi: 10.1164/rccm.201906-1185ST.

Background: Fungal infections are of increasing incidence and importance in immunocompromised and immunocompetent patients. Timely diagnosis relies on appropriate use of laboratory testing in susceptible patients.Methods: The relevant literature related to diagnosis of invasive pulmonary aspergillosis, invasive candidiasis, and the common endemic mycoses was systematically reviewed. Meta-analysis was performed when appropriate. Recommendations were developed using the Grading of Recommendations Assessment, Development, and Evaluation approach.Results: This guideline includes specific recommendations on the use of galactomannan testing in serum and BAL and for the diagnosis of invasive pulmonary aspergillosis, the role of PCR in the diagnosis of invasive pulmonary aspergillosis, the role of ß-d-glucan assays in the diagnosis of invasive candidiasis, and the application of serology and antigen testing in the diagnosis of the endemic mycoses.Conclusions: Rapid, accurate diagnosis of fungal infections relies on appropriate application of laboratory testing, including antigen testing, serological testing, and PCR-based assays.

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Candidiasis Fungal Infections
Ratings
Specialty Area Score
Infectious Disease
Intensivist/Critical Care
Respirology/Pulmonology
Hospital Doctor/Hospitalists
Internal Medicine
Family Medicine (FM)/General Practice (GP)
General Internal Medicine-Primary Care(US)
Comments from MORE raters

Hospital Doctor/Hospitalists

This is a thorough summary of existing evidence. It's useful information for hospitalists at tertiary-care centers, frequently caring for patients with complex comorbidities and immunocompromise.

Infectious Disease

A very important updated resource for clinicians.

Intensivist/Critical Care

As an intensive care physician working in a hematology/oncology hospital, I find these guidelines are directly relevant to my practice, caring for highly immunocompromised patients. For those working in general medical/surgical or neuro/trauma ICUs (especially outside areas where infections from dimorphic fungi are uncommon), they may be less relevant to clinical practice

Although not all recommendations are based on strong evidence, this is an updated review of the literature that should be helpful to clinicians.

Internal Medicine

Good information that is more pertinent to ID doctors.

This is a very useful guideline for Dx of fungal infections in hospitalized patients. The addition of the GRADE ratings is helpful to assess the strength of the recommendations.

Respirology/Pulmonology

This evidence-based guideline provides new recommendations based on the current literature for diagnosis of fungal respiratory infections. Some of the individual questions have been addressed by multiple meta-analyses or by trials not included in the latest meta-analysis, so in that way the guideline provides some new information. I am unaware of an existing guideline of this scope and quality on this specific topic.

These guidelines serve as a good review with many take home points for a busy non-ID clinician.

This is a well done analysis of the diagnosis of fungal infections in pulmonary and ICU patients. It points out limitation of using a single diagnostic test in caring for these patients.

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