Turk J Hematol. 2014; 31(4): 342-356 | DOI: 10.4274/tjh.2014.0218

Diagnosis of Invasive Fungal Diseases in Hematological Malignancies: A Critical Review of Evidence and Turkish Expert Opinion (TEO-2)

Sevtap Arıkan Akdağlı¹, Alpay Azap², Figen Başaran Demirkazık³, Beyza Ener⁴, Sibel Aşcıoğlu Hayran⁵, Özlem Özdemir Kumbasar⁶, Gökhan Metan⁷, Zekaver Odabaşı⁸, Ömrüm Uzun⁵, Hamdi Akan^9
1Hacettepe University, Faculty Of Medicine, Department Of Medical Microbiology, Ankara, Turkey
²Ankara University, Faculty Of Medicine, Department Of Infectious Diseases And Clinical Microbiology, Ankara, Turkey
³Hacettepe University, Faculty Of Medicine, Department Of Radiology, Ankara, Turkey
⁴Uludağ University Faculty Of Medicine, Department Of Microbiology, Bursa, Turkey
⁵Hacettepe University, Faculty Of Medicine, Department Of Infectious Diseases, Ankara, Turkey
⁶Ankara University, Faculty Of Medicine, Department Of Pulmonary Diseases, Ankara, Turkey
⁷Erciyes University, Faculty Of Medicine, Department Of Infectious Diseases And Clinical Microbiology, Kayseri, Turkey
⁸Marmara University, Faculty Of Medicine, Department Of Infectious Diseases, Istanbul, Turkey
⁹Ankara University Medical School, Department Of Hematology, Ankara, Turkey

One of the most problematic issues in hematological malignancies is the diagnosis of invasive fungal diseases. Especially, the difficulty of mycological diagnosis and the necessity of immediate intervention in molds have led to the adoption of “surrogate markers” which does not verify, but strongly suggests fungal infection. The markers commonly used are galactomannan (GM), beta-glucan and imaging methods. Although there are numerous studies on these diagnostic approaches, none of these markers serve as a support for the clinician, as is in human immunodeficiency virus (HIV) or cytomegalovirus (CMV) infections. This paper has been prepared to explain the diagnostic tests and show the clinician how the available resources can be used. As moleculer tests have not been standardized and not used routinely in the clinics, they will not be mentioned here.

Keywords: Diagnosis, Invasive fungal infection, Imaging, Serology

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Hematolojik Malignitelerde Görülen İnvazif Fungal İnfeksiyonların Tanısında Tanı Araçları: Kanıtlara Eleştirel Bakış ve Türk Uzman Görüşleri (TUG-2)

Sevtap Arıkan Akdağlı¹, Alpay Azap², Figen Başaran Demirkazık³, Beyza Ener⁴, Sibel Aşcıoğlu Hayran⁵, Özlem Özdemir Kumbasar⁶, Gökhan Metan⁷, Zekaver Odabaşı⁸, Ömrüm Uzun⁵, Hamdi Akan^9
1Hacettepe University, Faculty Of Medicine, Department Of Medical Microbiology, Ankara, Turkey
²Ankara University, Faculty Of Medicine, Department Of Infectious Diseases And Clinical Microbiology, Ankara, Turkey
³Hacettepe University, Faculty Of Medicine, Department Of Radiology, Ankara, Turkey
⁴Uludağ University Faculty Of Medicine, Department Of Microbiology, Bursa, Turkey
⁵Hacettepe University, Faculty Of Medicine, Department Of Infectious Diseases, Ankara, Turkey
⁶Ankara University, Faculty Of Medicine, Department Of Pulmonary Diseases, Ankara, Turkey
⁷Erciyes University, Faculty Of Medicine, Department Of Infectious Diseases And Clinical Microbiology, Kayseri, Turkey
⁸Marmara University, Faculty Of Medicine, Department Of Infectious Diseases, Istanbul, Turkey
⁹Ankara University Medical School, Department Of Hematology, Ankara, Turkey

Hematolojik malignitelerin tedavisinde önemli sorunlardan birisi de invazif fungal infeksiyonların tanısıdır. Mikolojik tanıdaki zorluklar ve hızlı müdahele etme gerekliliği, küf mantarlarının tanısında dolaylı işaretleyicilerin geliştirilmesine yol açmıştır. En sık kullanılan tanı testleri galaktomannan, beta-glukan ve moleküler yöntemlerdir. Her ne kadar bu tanı yöntemleri ile ilgili çok sayıda araştırma yapılmakta ise de, hiçbiri HIV ya da CMV’de olduğu gibi doğrudan yarar sağlamamaktadır. Tanı ile ilgili bu yazı klinisyene eldeki araçları kullanma konusunda yol göstermeyi amaçlamaktadır. Moleküler testlere henüz standardize edilmediği ve klinik kullanıma girmediği için bu yazıda değinilmeyecektir.

Anahtar Kelimeler: Tanı, İnvazif fungal infeksiyon, Görüntüleme, Seroloji

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