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AMSResist the ResistanceAct now. Act how?Strategy to prevent catastropheSurveil. SurvivePolicy for PurposeBacterial InfectionsBacterial basicsDetection and selectionKnow the negativeThe HAP/VAP recapDispel the MBLPinpoint the positiveGo-to guidelinesFungal InfectionsFungal factsFind the fungiPolice the yeastBehold the mouldFight the fungiViral InfectionsVerdict on virusesResourcesViral Infections



Resist the ResistanceAct now. Act how?Strategy to prevent catastropheSurveil. SurvivePolicy for Purpose
Find the fungi

Only about half of invasive fungal infections (IFIs) are detected before death.1,2


Given the high morbidity and mortality of IFs, an early and accurate diagnosis is more important than ever. This will help patients get prompt and appropriate treatment and may reduce unnecessary use of antifungals - both key aspects of stewardship.1-3

Yet, diagnosis of IFs remains challenging. Clinical manifestations and imaging features vary across infections, and for most fungal pathogens no rapid and sensitive diagnostic methods exist. Where they do, access is unevenly distributed across the globe - particularly problematic in low-resource settings, where the disease burden is highest. This can render diagnosis almost impossible, and prophylaxis and empiric treatment are relied on as the standard of care in many institutions.3-9


Diagnostics are an essential instrument in the stewardship toolbox. They improve fungal infection management and contribute to surveillance data gathering, helping in the fight against antifungal resistance (AFR).6,7

Establishing a diagnostic-driven approach can help improve patient outcomes and achieve stewardship goals.10,11 For example, selecting a treatment based on evidence from diagnostic tools can lead to a more targeted and effective treatment.12,13 This approach can lead to appropriate, targeted antifungal therapy, which is key to managing IFIs in line with the principles of antifungal stewardship (AFS), and can potentially improve AFS measures such as antifungal consumption, mortality, and length of stay.10-13


Culture from a clinical sample is the gold standard. However, this method is associated with some limitations:9,14

  • Delayed results
  • Low sensitiviity for candidiasis
  • Low specificity for aspergillosis and invasive mould infections
  • High level of expertise required to identify less common fungi
In addition, there are a variety of approaches available to identify IFIs. Some of the current diagnostic tools include:13
Microbiology                 Histology                           Radiology           
Microscopy Histopathology CT scan
Antigen testing and molecular techniques   MRI scan
Lateral flow test devices
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TitleExample Text Read more about diagnostic techniques in the BSMM (British Society for Medical Mycology) best practice recommendations.13 Read more


New techniques are emerging that allow faster diagnoses. But different types of fungal

infections need their own tactics. More below.

What tools are available to diagnose invasive yeast infections?

TitleExample Text Police the yeast Find out
AFR, antifungal resistance; AFS, antifungal stewardship; BSMM, British Society for Medical Mycology; CT, computerised tomography; IFI, invasive fungal infection; MRI, magnetic resonance imaging; PC, polymerase chain reaction.ReferencesDignani MC. F1000Prime Reports 2014;6:81.Von Lilienfeld-Toal Met al. Dtsch Arztebl In 2019;116:271-278.O'Neill J. Tackling Drug-Resistant Infections Globally: Final report and recommendations the review on antimicrobial resistance. Available at: Accessed August 2023.World Health Organization. WHO releases first-ever list of health-threatening fungi. 2022. Available at: https:// Accessed August 2023.World Health Organization. WHO fungal priority pathogens list to guide research, development and public health action. 2022. Available at: Accessed August 2023.Pfizer. Antimicrobial surveillance. Available at: antimicrobial-surveillance. Accessed August 2023.Fisher MC et al. Nat Rev Microbiol 2022;20(9):557-571.Zhang H and Zhu A. Infect Drug Resist 2020;13: 607-615.Kanj SS et al. J Fungi 2022;8 (11):1146.Chakrabarti A et al. Open Forum Infect Dis 2022;9 (7):ofac234.Xess I et al. J Fungi (Basel) 2022;8(8) Kort EA et al. Med Mycol 2019;57 (Supplement_3):S267-S273.Schelenz Set al. Lancet Infect Dis 2015;15(4):461-474.Kozel TR and Wickes B. Cold Spring Harb Perspect Med 2014;4(4):a019299.
Fungal infections
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