Immunodiagnostic Assays for the Investigation of Fungal Outbreaks
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REVIEW
Immunodiagnostic Assays for the Investigation of Fungal Outbreaks Diego H. Caceres
. Tom Chiller . Mark D. Lindsley
Received: 27 November 2019 / Accepted: 25 April 2020 Springer Nature B.V. 2020
Abstract Fungal pathogens can affect humans, animals, and plants, and they can be found in the environment or as part of the host microbiome. Fungal diseases present a broad clinical spectrum, ranging from superficial to invasive infections, and can cause outbreaks. During an outbreak investigation, the laboratory plays an essential role in verifying the diagnosis and helping to confirm the source of the outbreak. Immunodiagnostic assays are important tools and often relied upon for the diagnosis of fungal infections, since the gold standard assays of culture and histopathology are time-consuming and often require invasive procedures. Immunodiagnostic assays range from complement fixation and immunodiffusion to enzyme immunoassays and, most recently, to point-of-care lateral flow devices. In general, these assays provide results faster and offer
Handling Editor: Ferry Hagen. D. H. Caceres T. Chiller M. D. Lindsley Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA D. H. Caceres Center of Expertise in Mycology Radboudumc/CWZ, Nijmegen, The Netherlands M. D. Lindsley (&) Mycotic Diseases Branch, Centers for Disease Control and Prevention (CDC), 1600 Clifton Rd. NE, MS H17-2, Atlanta, GA 30329-4027, USA e-mail: [email protected]
good analytical performance. These characteristics make immunodiagnostic assays good laboratory tools for outbreak investigations. The aim of this review is to describe the principles, advantages, limitations, and availability of immunodiagnostics assays in outbreak investigations, based on the experience of a reference laboratory. Keywords Outbreaks Immunodiagnosis Antigen Antibody Fungal metabolites Mycosis
Introduction An outbreak is defined as a substantial increase above the expected number of disease cases in a population during a specific period of time [1, 2]. Surveillance systems are crucial for outbreak detection and response, but public health surveillance is not conducted for most fungal diseases, limiting timely identification and rapid response to increases in infections [3, 4]. The diagnosis of fungal infections is often not considered in the initial response to an outbreak, delaying proper treatment. Most fungal disease outbreaks are detected by alert clinicians, veterinarians, and other health professionals, who include fungal infections in the differential diagnosis and order appropriate diagnostic laboratory tests. These professionals, who then report their findings to
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public health authorities, are critical in bringing about a full investigation involving a multidisciplinary team including epidemiologists, laboratorians, clinical staff, veterinary staff, environmental professionals, and others [1]. Laboratory diagnosis of fungal diseases range
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