Pathogen identification by nuclear imaging – almost there?

Excerpt

Invasive fungal disease (IFD) in immunocompromised patients is a major infective cause of morbidity and mortality, with rates of death up to 90 % [1]. A key factor is the challenge of early diagnosis of IFD. In patients with haematological malignancy following intensive chemotherapy, immunosuppression and/or allogeneic haematopoietic stem cell transplantation, it is rarely possible to obtain the diagnostic material to definitively establish the presence of an IFD. The reasons for this are multiple, and include profound pancytopenia and poor performance status, which make tissue sampling of the lung (the main site for invasive aspergillosis, IA) hazardous. Equally, laboratory biological tests for IA have shown limited efficacy in the setting of blood sampling [2, 3], whereas bronchoalveolar lavage fluid appears to be a better material to assay, but bronchoscopy is an invasive intervention and may not be possible in an ill patient. All these factors, combined with post-mortem data showing higher rates of IFD than diagnosed ante-mortem [4], have led to empirical therapy as the standard of care in many centres around the world. The definition of empirical IFD therapy used throughout the literature is the commencement of treatment based on the clinical scenario alone, with the commonest situation being persistent neutropenic fever despite the use of broad-spectrum antibiotics. …