Diagnosis of invasive respiratory mycoses in the immunocompromised host : Current Opinion in Pulmonary Medicine

Secondary Logo

Journal Logo

INFECTIOUS DISEASES: Edited by Alimuddin Zumla and David SC Hui

Diagnosis of invasive respiratory mycoses in the immunocompromised host

Houston, Hamisha,b; Wilson, Andrew J.c; Stone, Neila

Author Information
Current Opinion in Pulmonary Medicine 29(3):p 149-159, May 2023. | DOI: 10.1097/MCP.0000000000000955


Purpose of review 

The burden of invasive fungal infection is increasing worldwide, largely due to a growing population at-risk. Most serious human fungal pathogens enter the host via the respiratory tract. Early identification and treatment of invasive fungal respiratory infections (IFRIs) in the immunocompromised host saves lives. However, their accurate diagnosis is a difficult challenge for clinicians and mortality remains high.

Recent findings 

This article reviews IFRIs, focussing on host susceptibility factors, clinical presentation, and mycological diagnosis. Several new diagnostic tools are coming of age including molecular diagnostics and point-of-care antigen tests. As diagnosis of IFRI relies heavily on invasive procedures like bronchoalveolar lavage and lung biopsy, several novel noninvasive diagnostic techniques are in development, such as metagenomics, ‘volatilomics’ and advanced imaging technologies.


Where IFRI cannot be proven, clinicians must employ a ‘weights-of-evidence’ approach to evaluate host factors, clinical and mycological data. Implementation studies are needed to understand how new diagnostic tools can be best applied within clinical pathways. Differentiating invasive infection from colonization and identifying antifungal resistance remain key challenges. As our diagnostic arsenal expands, centralized clinical mycology laboratories and efforts to ensure access to new diagnostics in low-resource settings will become increasingly important.

Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

You can read the full text of this article if you:

Access through Ovid